public health capstone project examples

Thesis and Capstone Requirements for Public Health Programs

Most graduate programs in public health include a thesis or capstone project, which students usually undertake after completing other coursework. While completing these projects, students must apply knowledge and skills gained throughout the program. The thesis or capstone tests the student’s ability to make a unique contribution to their field while demonstrating mastery of the subject.

These culminating projects reflect the kind of work students will do during the course of their careers.

These culminating projects reflect the kind of work students will do during the course of their careers. Public health students may complete an academic article or a detailed plan for dealing with the outbreak of a disease. Some projects involve working alongside professionals in the field, while others require significant research in archives and libraries. The completed thesis or capstone project demonstrates the student’s ability to perform duties within the public health field.

What’s the Difference Between a Capstone and a Thesis in Public Health Programs?

A thesis is an academic article that presents an argument or research findings. Common in graduate programs, thesis projects are often by an adviser or other faculty member. Capstone projects take various forms and, although more common in undergraduate studies, may be a requirement of master’s programs. Capstones are often research projects presented in a non-article format and involve hands-on experience.

What Is a Capstone Like in Public Health Programs?

Public health capstone format.

Capstones are typically independent projects, which students undertake toward the end of their program.

Capstones can take a variety of forms, but they generally consist of written and oral portions. The written portion could be a short article or a summary of findings, while the oral portion may involve a presentation at a conference. Capstones are typically independent projects, which students undertake toward the end of their program. A capstone may last one or two terms. Some programs allow students to choose project topics and begin research early.

Choosing Your Public Health Capstone Topic

Typically, students choose a capstone topic relevant to their specializations and career interests, which one or more faculty members must approve. Capstone projects are an opportunity to build connections with public health professionals. Capstone topics often address contemporary problems in the field, and individual programs or faculty may provide a selection of topics from which students must choose. Some programs pair students with faculty advisers.

Completing Your Public Health Capstone

Regardless of the capstone format, a few aspects are generally the same. Students first choose a topic or research question on which to base the project. Learners may conduct research to determine the limits of the project or may simply complete an outline. Before beginning on a capstone project, one or more faculty members must approve the student’s topic; the faculty member may be the student’s adviser or the professor of the capstone course. After receiving approval, the student can begin further research, project development, and execution of the capstone. Methods and resources vary based on the student’s field, subfield, and specialization.

Presenting Your Public Health Capstone

Presentation circumstances vary by program, but students generally present their capstone to a panel of three to five faculty members. These presentations are often open to the public and may include an opportunity for audience members to ask the student questions. Though visual aids such as slideshows and videos are common, the project’s subject and format guides presentation methods.

How Is a Public Health Capstone Graded?

While students may receive a rubric, master’s-level capstone projects rarely receive letter grades. These projects are typically pass or fail, though some students may pass with distinction. While it is possible to fail a capstone, students rarely fail a capstone they have completed and presented; advisers ensure the project is of passing quality.

What Is a Thesis Like in Public Health Programs?

Public health thesis format.

A thesis is an individual project, typically a piece of academic writing based on research, sometimes involving experimentation.

A thesis is an individual project, typically a piece of academic writing based on research, sometimes involving experimentation. A faculty adviser generally oversees the student’s completion of their thesis project. Some programs require students to present their thesis. The amount of time allotted to complete a thesis project varies by program and depends largely on how early the student may submit a topic for approval. Many programs require students to enroll in a thesis course, or courses, which allows the program to award credit for the project and provides a specific time for students to meet with advisers and complete thesis work.

Choosing Your Public Health Thesis Topic

While completing their thesis project, students typically work with a faculty member who approves their topic, suggests sources or methods, and helps guide the student through the research and writing processes. Though some programs specify certain topics or stipulate that students address a current issue, students generally have the final say regarding their thesis topic. The main requirement of thesis topics in public health is that they contribute to the field.

Completing Your Public Health Thesis

The first step to writing a master’s of public health thesis is choosing an approved topic. Students must then research and write about that topic. Students must typically obtain approval early in the process and must usually check in with advisers regularly as they progress. The format of the thesis project varies by field and school. Learners typically submit their thesis to advisers, who suggest changes and additions before the student submits the thesis to the school for digital or physical publication and inclusion in the school’s library or archives.

Presenting Your Public Health Thesis

A thesis presentation often involves questions from a panel of advisers and other faculty. These questions should help clarify and further define aspects of the thesis. While a presentation may include a slideshow or other aids, the focus of the presentation should be on replying to the panel’s concerns, rather than presenting new information. Most thesis presentations are open to the public, and audience members are usually allowed or encouraged to ask questions, though they may not have read the thesis itself. Students typically present after submitting their thesis to advisers but before finalizing the project and submitting it to the school.

How Is a Public Health Thesis Graded?

Most programs grade thesis papers pass or fail. A thesis is the culmination of a student’s education and is designed to be a challenging but ultimately successful process. A good adviser works directly with the student to ensure the final version of the student’s thesis is passing quality.

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Students in the Masters of Public Health (MPH) program are required to complete a Capstone project to address a public health issue through the lens of management; quality improvement; program planning, implementation or evaluation; policy; practice; or research. The capstone is undertaken near the end of the course of study and all required MPH courses should be completed prior to registering for the Capstone course (MPH 699).

The capstone project is a self-directed, independent endeavor completed with guidance from the capstone course manager, a capstone advisor (first reader), and an external partner (second reader). Group capstones may be available in special circumstances, under the direction of the capstone course manager. The level of effort and amount of time spent on the capstone is expected to approximate the level of effort of a one-semester, 3 credit course. Capstone presentation dates are available during the fall and spring semesters.

Capstone projects should ideally be designed to benefit a community partner or program, including efforts within the Muskie School’s Cutler Institute.

The Capstone project encompasses four assignments:

• Written proposal (non-graded) – The proposal must be approved by the advisor and first reader prior to the proposal presentation.
• Proposal presentation (non-graded) – Students will receive feedback from faculty and others. Visual aids are encouraged.
• Capstone (graded) – This will be a written product appropriate to the topic, created after carrying out the work of the proposal.
• Final presentation (graded) – Students will present the project and its findings to faculty, students, and other interested parties. The presentation will include a discussion with the audience. Visual aids are encouraged.

Completed capstones from former students are available through Digital Commons .

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Public Health Capstone Projects

Capstone projects from 2017 2017.

Incorporating Health Activities into the Friends of the Park Agenda: A Health Program Plan Framework , Hayley Hamilton

Analysis of the Quality, Integration, and Cost-effectiveness of Primary Care, Electronic Health Records, and End of Life Care: Lessons from the American Healthcare System to Inform National Health Insurance in the Bahamas , Brittney Jones

Geographic Information Systems Analysis of Walkability Data for the Atlanta Beltline Communities , Michale Kanchik

The Legacy for Children™ Program-- A Capstone on Fidelity Monitoring and Certification , Camille Kramer

Effectiveness of Pharmacist Delivered Medication Reconciliation Interventions on Hospital Readmission Rates: A Literature Review , Charles S. Lee

Factors Leading to Occupational Injuries and Illnesses among Hispanic Construction Workers in The United States: A Systematic Review , Luis Felipe Leon Cubides

Analysis of Anti-Retroviral Procurement for HIV-Affected Countries from Fiscal Years 2012 to 2014 , Dejene' Marshall

From Coverage to Care Implementation Plan , Michelle Mavreles

Bicycling for Transportation at Georgia State University: Findings and Recommendations for the Georgia State University Bike Plan , Sarah Braunstein McCartha

Categorizing Vending Machine Snacks at GSU for Metabolic Syndrome Dietary Recommendations , Allie Micheli

Lessons Learned and Recommendations for Conducting Research on the Effects of a Child Neglect Prevention-Focused Parent-Child Interaction Module (SafeCare PCI) on Home Language Environment and Toddler Expressive Language , Ambra Noble

Methodology to Cultivating Hand Hygiene Compliance in Healthcare Facilities , Ugo Okeke

A Review of the Relationship between Screen Time and Low Levels of Physical Activity with Obesity and Sedentary Behaviors in Children and Adolescents , Christal S. Oliver

Framework Analysis: Potential Repatriation and Mental Health System Recovery in the MENA , Yasmin Othman

A Program Evaluation of a Peri-Urban, Multi-Location Care Coordination Program in Georgia and Comparative Analysis of Other United States Care Coordination Programs for Uninsured, High-Risk Patients to Develop Promising Practice Recommendations , Amanda Parker

Effects of Exposure to E-cigarette Advertising on Adolescents: A Systematic Review , Paayal Patel

An Evaluation of Asthma Surveillance Packaging and Dissemination Efforts in Georgia , Lauren Potts

A Historical and Political Review of the Response to the 2015-2016 Zika Outbreak in Puerto Rico , Laura Riquelme

Evaluating the Role of Health Literacy in Communities: A Review of Community Health Needs Assessments of Georgia Hospitals , Brittany Robinson

A Qualitative Review of Healthcare Provider Interventions on Osteoporosis-Related Care and the Improvement on Patient Outcomes , Cayla Roby

A Grant Proposal to Fund Prevention Education for Teen Pregnancy, HIV, and Other Sexually Transmitted Infections in Targeted High Schools in Gwinnett County, Georgia , Connie Lynn Russell

Assessment of Current Lead Fact Sheets for Development of a Revised Lead Fact Sheet , Michael Sparks

A Comparison Analysis Between the State of Georgia and Israel: Heath Outcome Disparities of Low Birth Weight Infants , Dionne Spears

Encouraging Recruitment of Under-Represented Groups in Clinical Studies: A Sponsor's Perspective , Stephanie Stennett

Bankhead versus Buckhead: Analyzing the Environmental Justice Issues in Atlanta , Kristen G. Vales

Capstone Projects from 2016 2016

Assessment of Disparities in Health Care Access and Health Outcome among Racial and Ethnic Minorities , Nadia S. Al-Amin

Research Proposal for Developing Best Practices for Promoting Timely Follow Up Care for Patients in Non-rural Settings Discharged from Inpatient Psychiatric Care with Comorbid Chemical Dependency , Ryan Brody

Diet Technicians in Dialysis: A Rare Opportunity to Decrease Costs and Improve Quality of Care , Lauren Clark

Comorbidity: A Neglected Aspect of the Burden of RA , Andrea Cole

“Al Volante de su Salud”, A Driver’s Health is at His Seat: Research Proposal of a Survey Instrument to Measure the Health Status of Hispanic Taxi Drivers , Edda Cotto-Rivera

Prioritizing Environmental Hazards Through Focus Groups in NPU-V and Proctor Creek Watershed, Atlanta, Georgia , Molly Dunham-Friel

The Development of an Employee Wellness Program Within a Mid-Sized Company , Patricia J. Elkon

Risk Factors for Sex Work Recidivism in Commercial Sexual Exploitation Victims , Oluwatominsin O. Falegan

A Systematic Review of the Efficacy of Environmental Decontamination and Personal Hygiene Practices in Reducing Methicillin Resistant Staphylococcus aureus Acquisition , Rhe'a Green

Guide to Pediatric Audiology in Georgia , Kelly Hermanns

Midwives and Traditional Birth Attendants (TBAs) Partnership Program in Indonesia: A Proposed for National Guidelines , Rudi Hermawan

Evaluation of Access to Care: Minority and Low-income Populations and Non-profit Health Organizations , Erika Hooper

Investigating the Implementation of a Conditional Cash Transfer Program in DeKalb County, GA , Breana M. Jones

How Do Teachers Overcome the Perceived Barriers of Using the Universal Design for Learning? , Christina Martin

Smoking Media Literacy and Smoking Behavior among Adolescents in Indonesia: a Research Proposal , Ranti Kemala Nastasia

Evaluation of an Integrated Mindfulness Parenting Program For Parents in a Low SES Neighborhood , Josephine Ojo

Review of Omphalitis Interventions in India, Nepal and Pakistan Using Proximal, Intermediate and Distal Risk Factors , Nina Patel

Short Staffed: Assessing the Effects of Primary Care Physician Shortages and Policy Recommendation for Georgia , Kimberly Ramseur

A Qualitative Review of the Supplemental Nutrition Assistance Program (SNAP) and Recommendations for Improving Nutritional Output , Shefa F. Saulat

Prevention of Hospital-Acquired Methicillin-Resistant Staphylococcus Aureus in U.S. Pediatric Inpatients: A Systematic Review , Rachel See

Improving Volunteer Engagement: Results of a Staff Needs Assessment at a Community Based Organization , Telania Thomas

Household Waste Disposal Laws in the Federal Republic of Nigeria , Omenka Helen Uchendu

Mandated Reporting in Georgia: A Policy Recommendation and Rationale for Why Mandated Reporter Training Should be a Requirement , Amanda Wilcox

Development of a Social Norms Theory Based Alcohol Safety Marketing Campaign for GSU Using an Applied Social Norms Theoretical Approach , Sonia Williams-Aghimien

A 50-State Survey of Bicycle Crash Reporting Policies , Kathryn D. Woei-A-Sack

Capstone Projects from 2015 2015

Evaluating the Implementation of a Tobacco-Free Policy across the 30 Institutions of the University System of Georgia , Elif Alyanak

A Synthesis of Home-based Palliative Care on Clinical Effectiveness, Cost-effectiveness and Quality of Life: Policy Implications Explored , Brittany Behm

Insurance Mandates for Diagnosis and Treatment of Children and Adolescents with Autism and Evaluative Data Sources: A Case Study of Two U.S. States , Sofia Campos Vidal Pires

An Evaluation of the Costs and Health Benefits Associated with an Overseas Voluntary HIV Screening Program for Refugees Undergoing Ressettlement to the United States , Michelle Canady

An Ecological Study of the Cholera Outbreak in Rural and Urban Areas of Haiti , Catherine Dorothy Emilien

Patient Centered Medical Home (PCMH) Patient Education Brochure Research Proposal , Michael Jarvis

A Formative Evaluation of Hire Hope: A Program Providing Career Opportunities for Victims of Sex Trafficking and Those At-Risk , Jennifer Koncul

Effective Community Events: An Implementation Toolkit for Older Adult Falls Prevention , Monica Patrice McKenzie

The Evaluation Plan for the Linkage to Care Peer Guide Training Program , Kasarah D. Phillips

Legislative and Policy Approaches For The Prevention of School Bullying: A Critical Appraisal of Cross-National Perspectives , Marni Segall

Reducing Youth Violence: The Role of Afterschool Programs , Cordero Tanner

Turn Down For What? The Run Down Before it Goes Down: A Comprehensive Sexual Health Education Program , Tunicia Walker

Come Grow With Us: An Action Plan for Morrow Community Garden , Tacita Williams

Safe Kids Fulton County: A Program Evaluation , Jamie Zimmerman

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Capstone Project

The Capstone Project is the culminating experience required for graduation from the Master of Public Health Program. MPH students apply the knowledge and skills learned in class to public health problems in a chosen skillset or area of interest under the guidance of a Capstone Mentor. The projects should be chosen to help students address their academic interests and afford them an opportunity to master advanced public health competencies. The MPH capstone satisfies the CEPH Integrated Learning Experience.

Supporting Students in Capstone

To support this process, students are required to take two semester-long Capstone courses, Capstone I and Capstone II. Capstone I will help guide students in selecting an appropriate project, identifying a mentor, and starting their project, while Capstone II will help guide them in completing their project, analyzing any results, and developing deliverables. At the end, students submit a written paper and deliver a 10-minute public presentation. The nature and scope of the capstone project is determined collaboratively by the student, Capstone Mentor, and their Capstone Instructor, but they should be scaled appropriately for the time frame available.

Your Capstone Team

MPH students are not alone in completing their Capstone Project at any point in the process; there are different support systems in place to carry you through from project formation to completion and delivery.

Who is your Capstone Mentor?

Your Capstone Mentor is a public health professional and expert in the field of your Capstone who helps guide you through the project. Students collaborate with and seek the counsel of their Mentor to ensure their project is conducted thoroughly, being mindful of standards of the field. A project can have mentoring team, such as a content mentor and a methods mentor.

Who is your Capstone Instructor?

Your Capstone Instructor is an MPH teaching faculty who leads your Capstone seminar courses. You could have the same Capstone I and II instructor or they could be different, but your instructor will be there throughout your project as a support system to answer questions, adjust scope, assist with hurdles, and maintain perspective. The Capstone I instructor supports you in creating or finding a project, identifying a Capstone Mentor, and setting up a plan to carry out the project. The Capstone II instructor picks up the project and guides you to completion, confirming what written deliverables are needed and assisting in the preparation of your 20 minute professional presentation.

What is the role of your Capstone classmates?

Your Capstone classmates are as much a resource as your Mentor and Instructor. Capstone I and II seminars use peer-review and shared learning to help students progress through their own project while supporting their peers on their projects. From sharing project hurdles and overcoming them to motivating each other through preparing written deliverables to serving as a practice audience for presentation “dry-runs,” your Capstone classmates are your biggest cheerleaders and another incredible support mechanism.

From the very first day of Capstone, I felt supported and encouraged enough to delve deep into my specific area of interest. I was able to thoroughly cement my research, policy analysis, and public speaking skills, all while actively advancing the current academic literature. Without the Capstone process, I wouldn’t be nearly as confident in calling myself a public health professional, and I am extremely grateful for the opportunity.

Michael Adjei-Poku

MPH Student

Halle’s Capstone Project in Urban Farming

My Capstone experience allowed me to make a real difference in a community I love. I wanted to give back and the guidance of my mentor really helped me make a tangible impact for an organization I’m passionate about. My mentor helped the Capstone process unfold organically which helped ease a lot of anxiety and doubt that I had. I gained a lot of confidence in my skill set through this experience.

Halle Watkin

Working with Capstone mentees is one of my favorite ways to engage with our MPH students. Supporting their ideas and public health passions to bring a Capstone project to fruition is a privilege and I am always amazed at the incredible work they do!

Heather Klusaritz

Capstone Instructor

Capstone Skills vs Content Area

MPH Students can tailor their Capstone Projects to the kinds of skills they want to learn and grow or  focus their efforts on numerous public health content areas to prepare them to be future public health professionals. Below is a non-exhaustive list of the content areas and skillsets our students have explored in their Capstone work.

Skills Gained

Community Needs Assessment (surveys, logic models, focus groups, key informant interviews)

Systematic / Narrative Review (quantitative and/or qualitative, thematic analysis)

Program Development (creating an intervention or curriculum)

Program Evaluation (quantitative and/or qualitative)

Policy Brief / Policy Analysis (evidence-based analysis)

Quality Improvement Programs (run charts, go-sees, additional quantitative and/or qualitative analyses, creating an A3, process mapping)

Public Health Education and Health Communication (pamphlets, podcasts, apps, websites, blogs, community resources, instructional seminar/training/curricula, online social media platform)

Creating a Survey or other Measurement Tool (quantitative and/or qualitative)

Research Projects (primary or secondary, quantitative or qualitative)

Community Based Participatory Research (stakeholder engagement, recruitment, organizing/running meetings, community engagement and needs assessments, team building)

Implementation Science Projects (quantitative and/or qualitative)

Data Analysis (quantitative and/or qualitative, GIS, epidemiology, large and small datasets)

Content Areas

Adolescent and Young Adult Health

Adverse Childhood Experiences (ACEs)

Aging, Memory, and Geriatric Health

Autism Spectrum Disorders (ASD)

Behavioral Economics

Cancer Risk and Screenings

Chronic Disease Issues

city planning and housing issues

communicable diseases

community health

criminal justice issues

driving safety

environmental health issues

food insecurity

Geography & Health

gender affirming healthcare needs

global health issues

gun violence

health journalism

health law and health policy

health literacy

healthcare decision making

homelessness and housing insecurity

hospital policies and practices

infectious diseases

intimate partner violence (IPV)

LGBTQIA+ healthcare needs

maternal and child health

Mental Health

oral health and public health dentistry

peer support and peer education

public health risk preparedness

race, systemic racism, and health disparities in various public health areas

refugee and immigrant health

reproductive health issues

substance use, addiction, and recovery

support for non-English speaking and ESL populations

vaccine intention and hesitancy

zoonotic and veterinary diseases (One Health)

My capstone project explores the integration of public health education into San Cristóbal, Galápagos. Working collaboratively with our partners in Galápagos, we have been able to produce several lesson plans and identify other routes outside of school to reinforce these topics. My time in Galápagos has been enriching and invaluable.

Darby Gallagher

MPH STudent

School of Social Sciences, Humanities, and Arts

Public health capstone projects.

• Cognitive Science Capstone Projects
• English Honors Theses
• Department of Anthropology - Open Access Policy Deposits
• Department of Cognitive Science - Open Access Policy Deposits
• Department of World Cultures and History - Open Access Policy Deposits
• Department of Economics - Open Access Policy Deposits
• Department of English - Open Access Policy Deposits
• Department of Spanish - Open Access Policy Deposits
• Department of History - Open Access Policy Deposits
• Department of Psychology - Open Access Policy Deposits
• Department of Sociology - Open Access Policy Deposits

Examining the Nutrition Environment of Food Pantries in the San Joaquin Valley During the COVID-19 Pandemic

• Sanchez, Kimberly Daphnie

Background: Food insecurity rates drastically increased during the COVID-19 pandemic contributing to high demand for emergency nutrition assistance. Prior research indicates emergency food distribution centers mainly offer food with limited nutritional value; since nutritional status may be worse among food insecure families, it is important to conduct research to inform policy and programmatic strategies to address both food insecurity and nutrition-related health disparities during a state of emergency.

Purpose: The study objectives were to: (1) assess the nutritional environment of emergency food distribution centers in the San Joaquin Valley, CA; (2) identify challenges food distribution centers encountered during the pandemic; and (3) provide policy and programmatic recommendations to improve access to and the availability of nutritious food to low-income communities.

Methods: A nutritional assessment was conducted with 19 emergency food centers in the San Joaquin Valley, California. A modified version of the valid and reliable Nutrition Environment Food Pantry Assessment Tool (NEFPAT) was self-administered by food pantries and banks during the pandemic. The six NEFPAT objectives were included, and we developed a seventh component to capture data on challenges encountered during the COVID-19 pandemic. Challenges of distribution sites were identified and differentiated by type of organization (i.e., food bank, food pantry, church).

Results: A total of 19 completed site assessments from 7 counties are included in the analysis. Using the NEFPAT classification score, all were either bronze (16%) or silver (84%). Analyses were stratified by the type of emergency food organization: church (47%) or other food pantry (53%). All sites (i.e., church and other pantries) reported experiencing a decrease in volunteers and staff. However, food pantries experienced an increase in quantity of clients while church pantries struggled with client retention. Logistical challenges were also mentioned, pantries experienced inconsistent food donations. Others expressed high levels of concern about COVID-19 safety but managed to remain open by using a drive-thru distribution model and promoting social distancing with limits on the number of clients allowed inside a building at a time.

Conclusion: Policy recommendations include increasing funding to smaller charitable nutrition assistance sites to support fresh produce access and funding for the implementation of nutrition policy guidelines to improve the food environment. Programmatic recommendations include the adoption for a nutrition ranking system for food pantries, implementation of nudges to improve the selection of healthier food items, and use of valid and reliable data collection instruments to inform decisions to tailor food options that are aligned with the medical/health and social needs of food pantry clients.

Diversity and Functional Prediction of Non-Synonymous SNPs in Human Chemosensory Genes

• Ramirez, Vicente Andres
• 1 supplemental ZIP

Health insurance coverage among farmworkers in California before and after the introduction of the Affordable Care Act (ACA): A mixed methods study

• Sandhu, Nimrat Kaur

Background: Previous studies have found that although health insurance coverage expanded for farmworkers after the introduction of the Patient Protection and Affordable Care Act (ACA), coverage levels were lower than the general population. California recently introduced policies to expand coverage for previously excluded undocumented workers. This study examines the impact of the ACA on insurance coverage for farmworkers and identifies barriers to further expansion.

Methods: A mixed methods approach was utilized. Weighted statistical analyses were conducted on the National Agriculture Worker Survey (NAWS) data for 2011-12, 2015-16 and 2017-18 to study health insurance coverage before and after the introduction of the ACA. Qualitative interviews were conducted with growers, healthcare providers and community-based organizations to examine ACA related changes in health insurance for farmworkers.

Results: The ACA led to doubling of health insurance coverage for farmworkers in California (32.0%: 2011-12 to 64.8%: 2017-18), with higher rates for documented (43.0%: 2011-12: to 77.7%: 2017-18) than undocumented workers (2011-12: 26.0% to 2017-18: 46.8%), which were lower than rates for non-agricultural workers (73%) . Barriers to obtaining coverage include the high cost of insurance for growers, high deductibles and copays for farmworkers and distrust of government agencies.

Conclusions: While the ACA led to significant improvements in health insurance coverage for farmworkers in CA, significant barriers remain for farmworkers seeking to obtain insurance and for growers seeking to provide coverage.

Policy Implications: States should consider funding a farmworker specific Medicaid program to provide health insurance coverage and care coordination across counties and states.

Geographic Clustering of Emergency Department Visits for Deliberate Self-Harm Injury in California 

• Jensen, Jordan

Exploring Advocacy Coalitions involved in California's Sugar-Sweetened Beverage Tax Debate

• Garibay, Kesia Karina

Since 1982, California has attempted to pass a tax on sugar-sweetened beverages (SSB). To date, none have been successful. This study describes the advocacy groups and the strategies and policy arguments used by stakeholders to support or oppose statewide SSB tax legislation in California. The article uses the Advocacy Coalition Framework (ACF) to identify coalition groups and their members as well as examine the strategies and arguments used in California’s statewide SSB tax policy debates between 1999 and 2018. We use a mixed methods analysis with a predominantly qualitative approach to identify stakeholders involved in the SSB tax policymaking process and explore their policy arguments and advocacy strategies to advance their policy positions. Data consist of 11 California legislative bills (94 documents) and 138 newspaper articles. SSB tax policy debate did receive media attention. We identified two advocacy coalitions involved in the debate: a public health coalition and an industry coalition. The public health coalition focused on arguments about the health consequences and financial benefits of SSB taxes. The industry coalition responded with arguments that focused on how SSB taxes would harm the economy. Both coalitions used various strategies to advance desired outcomes. The public health coalition used advocacy strategies such as media and research evidence. The industry coalition used advocacy strategies such as preemption, alliances, and financial resources. Although SSB taxation has faced substantial challenges at the state level in California, advocacy coalitions can gain insight from policymaker’s experiences involved in previous legislation to inform future efforts to pass obesity prevention-related policies.

Survey evidence on behavior of smokers and vapers to the introduction of a retail flavor ban on the retail outlets in California

• Fabian, Rudiel

Fast Food Consumption and Asthma-Related Emergency Room Visits, California Health Interview Survey, 2011-2016

• Valle, Kimberly

Reducing Information Inequality: A Participatory Intervention in a Rural, Diverse Community

• Estrada, Erendira

Background: CDC-funded Partnerships to Improve Community Health (PICH) is a collaborative of over 40 community organizations working together to create a culture of health in Merced County. Underlying the policies, systems, and environmental approach that guided PICH projects is a comprehensive communication plan. As part of that plan, formative evaluation conducted at the start of the project found that residents and community organizations identified a weak information infrastructure as a major barrier to health: Residents struggle to find timely, relevant information that can help them improve their health, while stakeholders face challenges knowing how to reach diverse audiences with critical health-related information.

Aim: In this manuscript, I describe the process of conducting a participatory health communication intervention designed to address issues identified in communication infrastructure. The process includes adaptation of this method and intervention, developed in urban Los Angeles, to the rural context of Merced County.

Methods: Participatory health communication asset mapping (PHCAM), a method and intervention, was used to identify structures (safe, trusted spaces that serve distinct health communication needs: Informational, conversational, connection).

Development: A six-step process in which community leaders/residents identify & validate communication structures.

Implementation: Successful implementation of the map will be indicated from its use by (1) organizations (to disseminate information) and (2) residents (to obtain information). For the first, potential uses of the map were demonstrated at a convening with all partners, followed by one-on-one training and toolkit dissemination. To promote community knowledge/use, multiple resident convenings will be held at sites on the map.

• 1 supplemental PDF

Understanding Smoking Preferences: Results from a Discrete Choice Experiment Amongst U.S. Adults

• Zarate-Gonzalez, Gilda Yvette

E-cigarette (vaping) use has increased dramatically in recent years. While switching to vaping might benefit cigarette smokers, there is a risk of increased use by nonsmokers. Adults (N=525) aged 18 to 88 years made choices between two alternatives that differed in policy-relevant characteristics. Nonsmokers preferred e-cigarettes over all other tobacco products (WTP $1.34). Nonsmokers showed a strong aversion to the addictiveness of the products and long-term health risks. Light and heavy smokers differed in their attitudes toward health risks, with heavy smokers being relatively unsensitive to long-term health risks compared to light smokers. Cost was a particularly important factor for nonsmokers. Marginal analysis suggests smokers were relatively unsensitive to price increases alone. Vaping is attractive for nonsmokers when they perceived health risks are low, suggesting that behavior change campaigns should focus on the health risks. Results also suggest that it may be difficult to get smokers to shift to vaping.

 Education and Life’s Simple 7: An evaluation of differential returns by sex, race, and childhood socioeconomic status

• Sta. Cruz, Shaina Marie

Few studies have examined whether the benefits of education for health differ across sociodemographic subgroups. We investigated whether educational attainment is associated with cardiovascular health, as measured by the Life’s Simple 7 (LS7) score, and whether the association differs by demographic characteristics. Data were obtained from the REasons for Geographic and Racial Differences in Stroke study ( N =8,759 participants; mean age=63.8).

We used linear regression analyses with interactions by sex, race, childhood socioeconomic status (SES), and geography. Socially vulnerable groups (i.e., men from low childhood SES backgrounds, White people from low childhood SES backgrounds, Black people from low childhood SES backgrounds) benefitted less from each additional year of education than socially advantaged groups in predicting LS7 scores. However, we did not find evidence that differential returns extended to every group. Findings suggest that the inequalities present in the education system may further exacerbate the gap between advantaged and disadvantaged.

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MPH Capstone experiences: promising practices and lessons learned

Associated data.

The data analyzed in this study is subject to the following licenses/restrictions: The data were collected for internal program evaluation. We did not request permission at the time of data collection to disseminate these raw data. Requests to access these datasets should be directed to ude.cnu@deirfdnal .

To ensure workforce readiness, graduate-level public health training programs must prepare students to collaborate with communities on improving public health practice and tools. The Council on Education for Public Health (CEPH) requires Master of Public Health (MPH) students to complete an Integrative Learning Experience (ILE) at the end of their program of study that yields a high-quality written product demonstrating synthesis of competencies. CEPH suggests written products ideally be “developed and delivered in a manner that is useful to external stakeholders, such as non-profit or governmental organizations.” However, there are limited examples of the ILE pedagogies and practices most likely to yield mutual benefit for students and community partners. To address this gap, we describe a community-led, year-long, group-based ILE for MPH students, called Capstone. This service-learning course aims to (1) increase capacity of students and partner organizations to address public health issues and promote health equity; (2) create new or improved public health resources, programs, services, and policies that promote health equity; (3) enhance student preparedness and marketability for careers in public health; and (4) strengthen campus-community partnerships. Since 2009, 127 Capstone teams affiliated with the Department of Health Behavior at the Gillings School of Global Public Health at The University of North Carolina at Chapel Hill have worked with seventy-nine partner organizations to provide over 103,000 h of in-kind service and produce 635 unique products or “deliverables.” This paper describes key promising practices of Capstone, specifically its staffing model; approach to project recruitment, selection, and matching; course format; and assignments. Using course evaluation data, we summarize student and community partner outcomes. Next, we share lessons learned from 13 years of program implementation and future directions for continuing to maximize student and community partner benefits. Finally, we provide recommendations for other programs interested in replicating the Capstone model.

Introduction

Responding to public health crises like the COVID-19 pandemic requires a public health workforce skilled in community partnership ( 1 , 2 ). Schools and programs of public health are thus charged with designing community-engaged learning experiences while also satisfying accreditation criteria ( 3 ). The accrediting body for schools and programs of public health, the Council on Education for Public Health (CEPH), requires Master of Public Health (MPH) students to complete an Integrative Learning Experience (ILE), which represents a culminating experience near the end of their program of study. The ILE must yield a high-quality written product (e.g., “program evaluation report, training manual, policy statement, take-home comprehensive essay exam, legislative testimony with accompanying supporting research, etc.”) that demonstrates synthesis of a set of competencies ( 2 ). Such products may be generated from practice-based projects, essay-based comprehensive exams, capstone programs, or integrative seminars ( 2 ). CEPH guidelines suggest ILE written products ideally be “developed and delivered in a manner that is useful to external stakeholders, such as non-profit or governmental organizations” ( 2 ).

Within this paper, we describe promising practices employed within a community-led, group-based, year-long, critical service-learning course, called Capstone, for MPH students within the Department of Health Behavior at the Gillings School of Global Public Health (Gillings) at The University of North Carolina at Chapel Hill (UNC-CH) ( 4 ). We explain the specifics of Capstone's staffing model; project recruitment, selection, and matching processes; course format; and assignments, all of which are designed to promote mutual benefit for students and community partners. Using internal and school-level course evaluations, we present findings on student and community partner outcomes. Next, we reflect on lessons learned from 13 years of implementation experience and suggest future directions for Capstone programming. Finally, we share recommendations for other programs interested in replicating Capstone. We hope the information presented in this paper will benefit other programs interested in ILEs that have mutual benefit for students and community partners.

Pedagogical framework

By design, Capstone is a critical service-learning course. Service-learning pedagogies and practices vary widely. Essential elements of service-learning include community-engaged activities tied to learning goals and ongoing reflection ( 5 – 7 ). The literature documents wide-ranging benefits students gain from service-learning programs such as improved critical thinking skills as well as stronger leadership, communication, and interpersonal skills ( 5 , 8 ). Participation in service-learning courses promotes program satisfaction ( 9 ), academic achievement ( 5 , 8 – 10 ), and job marketability ( 9 , 11 ) among students. Finally, service-learning experiences enhance students' civic engagement ( 2 , 4 , 7 ), cultural awareness, and practice of cultural humility ( 8 , 12 ).

Despite these benefits, service-learning implementation challenges are well documented. Service-learning courses require significant resources to cover program expenses and staffing dedicated to developing and maintaining community partner relationships ( 7 , 12 – 15 ). In addition, the academic calendar may not align with community partners' timelines ( 5 , 14 , 16 ). Students and community partners have additional responsibilities and competing priorities outside coursework, thus creating variable levels of engagement across program participants ( 13 – 15 , 17 , 18 ). In cases where students have nascent project management skills and limited professional experience ( 9 , 10 , 13 ), it can be difficult to achieve mutual benefits among students and community partners.

A prominent debate within the field is the degree to which service-learning projects perpetuate the status quo or facilitate social change. Specifically, researchers question which elements of service-learning best create the conditions for student learning and positive community transformation ( 5 , 19 – 21 ). To provide a framework for this debate, Mitchell ( 5 ) differentiates between “traditional service-learning” and “critical service-learning.” Traditional service-learning is often critiqued for prioritizing student learning needs over benefits to the community ( 5 , 21 ). In contrast, critical service-learning is explicitly committed to social justice ( 5 ). Key elements of a critical service-learning approach include: (1) redistributing power among members of the partnership; (2) building authentic relationships (i.e., those characterized by connection, mutual benefits, prolonged engagement, trust, and solidarity); and (3) working from a social change perspective ( 5 ).

Most service-learning program descriptions within public health training do not reference either a traditional or critical service-learning framework ( 8 , 9 , 11 , 13 , 14 , 22 , 23 ). Several published programs align with a traditional service-learning model, due to the exclusive focus on student benefits and the absence of an explicit commitment to power sharing, authentic partnerships, or social change. For example, Schober et al. ( 24 ) underscore service-learning as an effective means to train a younger workforce to address complex public health issues. Gupta et al. ( 8 ) describe the importance of self-reflection activities for personal growth and skill development, structured within a service-learning program for undergraduate students enrolled in a community nutrition course. While these courses contain many of the best practices in service-learning, including reflection, they discuss student outcomes without promoting or evaluating social change ( 6 ).

The literature also cites programs and courses that include elements of critical service-learning but do not use critical service-learning terminology. For example, a service-learning program at the University of Connecticut outlines how students contribute to structural changes and social progress through policy development and implementation as part of their applied practice experience, which culminates with a presentation to the state legislature ( 23 ). Additionally, Sabo et al. ( 12 ) describe a service-learning course at the University of Arizona oriented toward social justice, as the course is “modeled on the reduction of health disparities through exploration, reflection, and action on the social determinants of health” through strong community-academic partnerships across urban, rural, and indigenous settings. These examples highlight commitment to social progress, community impact, and equitable collaboration without overtly applying the language of critical service-learning.

A small number of service-learning practitioners define their programs explicitly as critical-service learning. Mackenzie et al. ( 13 ) document the benefits of a critical service-learning experience for undergraduate public health students, endorsing it as a “feasible, sustainable” high-impact practice. In their model, students partner with community organizations to address social determinants of health; analyze and challenge power dynamics and systems of oppression; and gain skills. As evidence of power sharing and social change, the authors document that communities have continued their partnerships with the university due to the expansive reach and impact of their collaborations. Authentic relationships were also developed as students gained a stronger sense of commitment to communities. Derreth and Wear ( 25 ) describe the transition to an online critical service-learning course as universities grappled with changing instructional formats with the onset of the COVID-19 pandemic. In this course, public health students collaborated with Baltimore residents to create evaluation tools while participating in reflective activities. As evidence of critical service-learning, they documented students' changed perspectives, ongoing commitment to collaborate with residents after the course, and development of strong connections with faculty. These courses show the possibilities of critical service-learning ILEs. Detailed descriptions of program structures are needed for interested faculty to replicate best practices. To assist others with adopting or adapting elements of critical service-learning ILEs, this paper provides specifics about Capstone programming.

Learning environment

Program overview.

Community-Led Capstone Project: Part I and II (Capstone) is a graduate-level course situated within UNC-CH's Gillings' Department of Health Behavior (Department). The Department developed Capstone in response to faculty concerns about the variable investment in and quality of master's papers ( 26 ), coupled with a desire to design a practice-based culminating experience driven by community partners' needs, interests, and concerns. Capstone satisfies CEPH ILE requirements and serves as the substitute for UNC-CH's master's thesis requirement for students in the Health Behavior (HB) and Health Equity, Social Justice, and Human Rights (EQUITY) MPH concentrations. The overwhelming majority of students in these two concentrations are full-time residential students pursuing an MPH within a two-year time frame, though there are a few students who are enrolled in a dual degree program to earn their MPH alongside a Master of Social Work (MSW) or Master of City and Regional Planning (MCRP) within 3 years.

During this year-long course, which occurs during the second year of the MPH program, students synthesize and apply their MPH training to community-designed public health projects. Supplementary material A , B include a list of HB and EQUITY required courses and their sequencing. The specific competencies applied and assessed during Capstone are listed in Supplementary material C . Each team of four to five Capstone students works with a partner organization and its constituents to produce a set of four to six deliverables (i.e., tangible products). Deliverables are based on the partner organization's self-identified needs. This community-led approach prioritizes partners' interests and gives students an opportunity to do applied public health work on a range of topics with a variety of organization types. Figure 1 details the tasks and timelines entailed in this programming. Table 1 presents information from selected projects that showcase the range of partner organizations, activities, and deliverables present in Capstone. Capstone's specific objectives are to (1) increase capacity among students and partner organizations to address public health issues and promote health equity; (2) create new or improved public health resources, programs, services, and policies that advance health equity; (3) enhance student preparedness and marketability for public health careers; and (4) strengthen campus-community partnerships.

Gantt chart illustrating major Capstone activities and timeline.

Sample projects.

Personnel and resources

Capstone involves numerous constituents and requires dedicated resources. Each partner organization is represented by one or two preceptors (i.e., main points of contact from the partner organization) who provide a vision for, direct, and supervise the project work. Preceptors spend 2–4 h per week meeting with students, providing guidance on the work, and reviewing deliverables. Student teams are responsible for managing Capstone relationships, processes, and tasks and producing deliverables that enhance their skillsets while meeting their partner organization's needs. They are expected to spend 6–9 h per week, outside of class time, on Capstone. One faculty adviser per project provides technical expertise and ensures that each team's project deliverables meet UNC-CH's master's thesis substitute and CEPH ILE requirements. Faculty advisers spend 30 min to an hour a week providing feedback and guidance on the project work. Advising a Capstone team every other year is a service expectation for Department faculty. The teaching team, which is comprised of course instructor(s) and teaching assistants (TAs), recruits the partner organizations and oversees and supports the Capstone experience. Each instructor manages ten to eleven teams (typically between forty and fifty students) and receives coverage equal to twenty percent full-time equivalent per semester. TAs, who are HB or EQUITY MPH alumni and/or HB doctoral students, each work with five to six teams and are expected to work 18 h a week on Capstone. TAs provide feedback on draft deliverables, direct students to resources, and help problem solve. Departmental administrative staff provide additional support to coordinate expenses associated with the program such as project-related travel, equipment, services (e.g., transcription, interpretation, translation), books, software, incentives, postage, and other costs. Capstone students pay a one-time $600 field fee to cover a portion of the expenses associated with Capstone. This fee was approved by the University and is paid when a student enrolls in the first semester of the course.

Project recruitment, selection, and matching

Recruitment.

The process of setting up Capstone projects takes 9 months of advance planning (see Figure 1 ). The Capstone teaching team solicits project proposals in December for the upcoming academic year. They send email solicitations with Capstone overview information ( Supplementary material D ) and the project proposal form ( Supplementary material E ) to current and former Capstone partner organizations, hosts of other experiential education experiences, and department listservs. The Capstone teaching team encourages recipients to share the solicitation information with their networks. Prospective partners' first step is to have an informational interview with a Capstone instructor to discuss their project ideas and to receive coaching on elements of successful proposals. These interviews are also an opportunity for the teaching team to assess an organization's capacity to support a student team and gain insights on the prospective preceptors' communication, work, and leadership styles. The teaching team invites prospective partners to submit draft proposals for their review prior to the proposal deadline. Prospective partners submit their finalized project proposals and a letter of support from their leadership to the teaching team by email in early February.

The teaching team typically receives twenty project proposals. To determine which projects will be presented to incoming Capstone students, a committee consisting of the teaching team and student representatives from the current Capstone class reviews and scores proposals based on the criteria listed in Table 2 . Reviewers score each criterion on a scale of one through five with one being the lowest score and five being the highest score. The fifteen community partners with the highest scoring proposals are invited to share their ideas with students via a recorded seven-minute project overview presentation.

Project selection criteria.

Incoming Capstone students have 1 week in March to review the proposal materials and rank their top five project preferences. Based on student rankings, the teaching team assembles project teams using the following guiding principles: (1) give as many students as possible their top-ranked project; (2) promote diversity of concentrations and experience levels within student teams; and (3) ensure the number of students per team is appropriate for the proposed scope of work. Once the student teams are assembled, the teaching team matches faculty advisers to projects based on faculty's interests and expertise. The teaching team announces final team composition in early April. The course instructor(s) facilitates an initial meeting with each student team, their preceptor(s), and their faculty adviser in May to build community, clarify expectations, and orient the student team to their project work and partner organization. Project work formally begins in August of the following academic year.

Course format

Capstone spans the fall and spring semesters (fifteen weeks per term) and is three credits per term. To help students, preceptors, and faculty advisers become familiar with expectations for Capstone, the teaching team reserves the first 4 weeks of the fall semester for onboarding. As part of the onboarding process, each team cocreates a team charter ( Supplementary material F ) to promote authentic relationships between students and their community partners and to clarify expectations for working together. They also produce a workplan ( Supplementary material G ), which elaborates on the partner's project proposal, to outline the team's scope of work. After the onboarding weeks, the teaching team meets with each student team during class three times per semester to receive project updates and provide support. The teaching team facilitates two whole-class reflection sessions per semester to help students make meaning of their experiences. All other Capstone class sessions are protected time for student teams to meet and work on their projects.

Course assignments

Capstone assignments are designed to ensure a mutually beneficial experience for students and community partners. They are also intended to facilitate critical reflection, yield high-quality written products, assess synthesis of selected competencies, and evaluate how students steward the relationships, processes, and tasks associated with their projects. To share power and collect their unique perspectives, preceptors and faculty advisers participate in the grading process. Tables 3 , ​ ,4 4 summarize course assignments, their descriptions, whether they are completed and assessed at the individual or group level, and the party responsible for assessing the assignment.

Capstone assignments for the fall semester.

TT, Teaching Team; P, Preceptor; FA, Faculty Adviser.

Capstone assignments for the spring semester.

Program evaluation

This study was exempted by UNC Chapel Hill's Institutional Review Board (IRB 21-0510) as it fell under the exemption category of “educational setting,” which includes research on instructional approaches and their effectiveness. To abstract and analyze data on the number of students who have completed Capstone, hours they dedicated to Capstone activities, and deliverables they produced, two authors referenced course records starting in 2009. The teaching team collects students' and preceptors' perspectives on Capstone through mid- and end-of-semester evaluations using Qualtrics. Gillings administers end-of-semester course evaluations that provide additional insights into student outcomes.

Core aspects of Capstone (e.g., program aims and our staffing model) have remained constant over the past 13 years. However, a variety of lessons learned and external conditions have led to program changes. Use of class time and project recruitment, selection, and matching processes have evolved to further promote health equity and maximize mutual student and community partner benefit. The EQUITY concentration joined Capstone in 2020, which led to changes in team composition. Furthermore, the COVID-19 pandemic necessitated a transition from in-person to a remote course format in academic years 2020 and 2021, introducing the opportunity to work with organizations across the nation.

To present qualitative findings that reflect our most current programming, two authors analyzed data from academic years 2020 and 2021. Ninety-eight students and twenty-two preceptors participated in Capstone during that time. The teaching team received a 100 percent response rate to their mid and end-of semester evaluations completed by students and preceptors and a seventy-two percent response rate to the Gillings-administered student course evaluations during academic years 2020 and 2021.

To identify key outcomes for students and preceptors, two authors completed a thematic analysis of evaluation responses ( 27 , 28 ). For students, they analyzed eighty-eight qualitative responses to the Gillings' course evaluation question, “What will you take away from this course?” Next, the two authors familiarized themselves with the data and inductively created a thematic codebook. To ensure consistent code use, they simultaneously coded approximately twenty-five percent of transcripts, coded remaining transcripts separately, and flagged any transcripts that required further review. To identify key preceptor outcomes, the two authors analyzed the twenty-two responses to the spring end-of-semester evaluation question, “Please describe how, if at all, your organization benefited from hosting a Capstone team.” They reviewed the responses to inductively create a codebook and then worked together to apply codes to all quotations to identify thematic groups.

Student outcomes

Since its inception in 2009, 574 students across 127 teams have completed the Capstone program, provided over 103,000 h of in-kind service, and produced more than 635 deliverables with our partner organizations. Between 2020–2022, ninety-eight students completed the current version of Capstone, provided 35,280 h of in-kind service, and produced eighty deliverables. Through our thematic analysis of course evaluation data, we identified two overarching themes for student outcomes: skill development and satisfaction.

Skill development, students' greatest takeaway from Capstone, was reflected in fifty-three percent ( n = 47) of students' qualitative evaluation responses. Students directly named interpersonal skills (e.g., communication, teamwork, collaboration, conflict management, facilitation, community engagement, coalition building) the most. They also commented on acquisition of technical skills (e.g., project management; content development; and data collection, analysis, and reporting). In most cases, students named a mix of skills in their responses. For example, one student said they will take away:

Skills developed on the project, including survey design and implementation as well as strategies for engaging with community advisory board authentically and successfully. Shared skills among team will stick with me as well – project management, inter–team communication, strategies for setting clear expectations and holding each other accountable.

Skill development helps achieve Capstone's course aims of increasing students' capacity to address public health issues and promote health equity while enhancing their preparedness and marketability for public health careers.

Twenty-four students commented on their satisfaction with the experience when sharing key takeaways. Seven students expressed dissatisfaction, primarily with course assignments, while seventeen others remarked on their satisfaction with the experience, particularly the applied format of the course. For example, one student shared,

This Capstone project really was special. Having a community partner that demonstrated how helpful these projects would be and work with us to shape the deliverables was such a unique process. I wish we had more community–focused classes like this one.

In alignment with Capstone's objective of strengthened campus-community partnerships and CEPH ILE goals, these Capstone partnerships afford students the opportunity to see the impacts of their learning and create meaningful work that benefits external constituents.

Community partner outcomes

Over the past 13 years, we have partnered with seventy-nine organizations representing a variety of sectors including healthcare, social services, education, and government. Twenty-five (31.6%) of our partner organizations have hosted multiple Capstone teams. Based on the twenty-two preceptor responses analyzed for this paper, two authors identified four major themes within community partner benefits: deliverable utility, enhanced capacity, broad impacts, and more inclusive processes. Sixteen (72.7%) preceptors said that they benefited from the deliverables (e.g., toolkit, communication tool, datasets, evaluation plan, report, oral history products, protocols, presentation, report, curriculum, manuscript, engagement plan) produced by their team. These findings reflect Capstone's course aim of creating new or improved public health resources, programs, services, and policies.

Fifty-seven percent ( n = 12) of preceptors noted that project outcomes would not have been possible without the support of a Capstone team. The resources teams developed increased partner organizations' capacity to further their work. For example, a preceptor shared:

The Capstone team provided us with SO many hours of highly skilled person power that we would not otherwise have had. We now have a draft of a thorough and high quality [toolkit], which I don't think could have been created without their labor, given the resource constraints of [our organization]. This toolkit will serve as a tool to start conversations with many […] stakeholders in the future. I think it will also serve as a model for other states.

Not only can students' in-kind service and the work they produce help increase the capacity of our partner organizations, but also the Capstone project work can have long-term and far-reaching impacts for public health practice at large. Indeed, preceptors ( n = 8) reported impacts that extend beyond the partner organization. For example, another preceptor noted,

[Our organization] will use the presentation and report that the Capstone team produced for the next decade. Not only will [our organization] benefit from advancing our strategic priorities and deepening our partnerships, but we believe this report will be used by other agencies across the county to advance behavioral health priorities in need of support.

This is an example of how Capstone can yield new and improved public health resources, programs, services, and policies that have lasting impacts beyond those directly benefiting our partner organizations.

A final theme that emerged was organizations' increased ability to implement more inclusive processes. Four preceptors commented on expanded commitment to equity initiatives as illustrated by the following quote:

The work the team did for [our organization] is work that we've talked about doing for several years - but we never had the time. The protocols are important for injured children, so we're grateful for the team's work. We also have never addressed social equity as a group. Working with this team has prompted us to take a look at our practices. The evaluation plan the students developed will provide a mechanism for us to assess and trend our implementation of the protocols and our efforts to reduce inequities in trauma care.

This example demonstrates how Capstone's commitment to working from a social change orientation can impact our partner organizations' cultures. Overall, these findings illustrate the myriad community partner benefits present within Capstone.

These results show that Capstone mutually benefits community partners and students. Overall, students gained skills in collaborating with communities and contributed to collective capacity to improve public health practice and tools for promoting health equity. Our finding that skill development was a key student outcome aligns with Mackenzie et al.'s ( 13 ) and Gupta et al.'s ( 8 ) evaluations of similar service-learning courses. Among skills developed, both studies cited teamwork and professional development skills as key components ( 8 , 13 ). Mackenzie et al. ( 13 ), Derreth and Wear ( 25 ), and Sabo et al. ( 12 ) also report additional student outcomes that were not explicitly measured in our evaluation, including a deeper commitment to work with local communities, a deeper commitment to engaged scholarship, and stronger relationships with faculty.

In our evaluation, community partners benefitted through useful deliverables, enhanced capacity to do more public health work, impacts beyond the scope of the project, and more inclusive and equitable processes. Like our study, Gregorio et al. ( 23 ) found that their students' work products were very useful. Moreover, the Mackenzie et al. ( 13 ) study cited that students were able to offer additional capacity to organizations by “extending the[ir] reach,” which reinforced our main findings of enhanced capacity and impacts beyond the scope of the project. While not all service-learning course evaluation studies included data from community partners, our results aligned with those that did.

Lessons learned

After 13 years, we have identified several lessons learned about implementing a critical service-learning ILE. First, despite proactive planning efforts, the teaching team has learned to expect challenges related to project scope and relationships. The solicitation and refinement of projects and partnerships starts 9 months before the beginning of Capstone. Through extended individualized support and engagement, the teaching team hopes to build trust with community partners and collaborate in shaping and strengthening their project proposals. While there are benefits of this level of engagement, no amount of planning completely insulates projects from the unforeseen challenges of community-engaged work. For example, the COVID-19 pandemic impacted how Capstone could engage with community partners, their priorities, and their staffing. In particular, preceptor turnover creates numerous challenges for team morale and project ownership, satisfaction, and impact.

Second, Capstone course assignments are designed to maximize positive experiences for students and community partners and to uphold the principles of critical service-learning, but students are often frustrated with them. The teaching team refers to the workplan and team charter as the “guardrails” of the Capstone. They exist to clarify expectations, promote power sharing and authentic relationships, and reinforce Capstone's commitment to social change. The teaching team has observed that teams who invest deeply in these documents are the least likely to encounter significant interpersonal and logistical setbacks during the experience. Despite the teaching team's messaging about the importance of these structures for mutually beneficial experiences, students routinely assert that the start of Capstone contains too much “administrative” work. While the teaching team continues to respect and incorporate students' critical feedback, they have learned to expect a certain amount of student dissatisfaction at the start of the experience.

Third, the Department has learned that having the appropriate amount of staffing and material resources to support projects is essential to ensuring positive impacts. Limiting partners to only those with material resources is one way that funding models both within public health and the non-profit sector often exclude organizations with more explicit social change agendas. Therefore, to maximize student learning and community partner benefit while minimizing community partner burden, Capstone has a high university-staff-to-project ratio and covers project expenses. To fund Capstone, the Department uses a combination of state resources and field fees. There is an enduring tension, especially because resources are scarce, to scale back spending on courses like Capstone. For experiences like these to sustain and grow, additional resources, not fewer, are needed.

Finally, programs like Capstone must adapt to shifting social, political, economic, and educational landscapes to ensure sustained positive impacts. For example, prior to the COVID-19 pandemic, the teaching team limited the eligible pool of Capstone community partners to those within a forty-mile radius of UNC-CH. The pandemic resulted in the teaching team broadening community partner eligibility criteria and now Capstone works with community partners across the nation. Capstone's expanded reach is aligned with the new vision for Public Health 3.0 where public health professionals are expected to “engage multiple sectors and community partners to generate collective impact” while improving social determinants of health ( 29 ).

Future directions for Capstone

Public Health 3.0 ( 29 ) looks to promote health, equity, and resilience. With more community partners working on projects that explicitly tackle upstream factors like education, housing, and poverty in addition to health, Gillings will need to update its MPH training program to ensure that students enter their ILEs with the skills needed to meet these challenges. Below we describe ongoing quality improvement efforts internal to the Capstone program to strengthen outcomes for students and partner organizations.

The teaching team hopes to continue to enhance student preparedness and marketability for careers in public health. Much like other experiential learning models that report benefits to career readiness, professional leadership, and confidence ( 15 , 18 ), students report a host of positive outcomes from their Capstone experience that imply preparedness and marketability. Students note the breadth and depth of technical and interpersonal skills gained, as has been reported elsewhere ( 13 , 30 ). These reports of enhanced preparedness align well with findings that among undergraduate seniors seeking employment immediately after graduation, students whose course history included service-learning and capstone courses experienced greater odds of starting a new job compared with those who did not engage those high-impact practices ( 31 ). In recent years, the teaching team has offered skill-building workshops, as replicated in other programs ( 3 ), to coach students on how to present their Capstone work on résumés and how to talk about their projects during interviews using sample scripts. To simulate job applications and increase engagement with partner organizations, the teaching team will consider inviting preceptors to review and provide feedback on students' résumés and project description scripts.

The teaching team also aims to further strengthen community partnerships. One way to maximize Capstone's benefit for community partners is to adapt recruitment strategies so that the teaching team reaches more organizations for whom the Capstone experience would be most impactful. This may mean further refining the application process to lessen the time burden on potential partners and disseminating the call for Capstone projects through different channels. To enhance the experience of selected community partners, the teaching team plans to implement more preceptor-specific programming such as check-in meetings and skill-building workshops to build community and encourage collaboration among community partners.

Finally, there is a clear need for a comprehensive Capstone evaluation. The teaching team has yet to administer surveys, interviews, or focus groups that explicitly evaluate course aims and the elements of critical service learning. Furthermore, our understanding of the long-term impacts of Capstone is currently limited to anecdotal information from exchanges with former students and preceptors. By conducting a strategic evaluation, including modifications to existing course feedback opportunities and an additional alumni survey moving forward, we can better assess how Capstone is achieving course aims, operationalizing the elements of critical-service learning, and having long-term impacts.

Recommendations for program replication

Capstone's model can be adopted or adapted by individual faculty or by schools of public health. We welcome faculty members or program and school leaders to contact us to further discuss what this might look like. In general, though, we recommend that the following core components remain consistent:

• Program staff invest effort to ensure community partners understand the overarching goals of the experience, general timelines, logistics, and roles and responsibilities of all involved parties prior to submitting a project proposal.
• Community partners are selected using clearly defined criteria, including equity.
• Community partners lead the development of, and direct, students' scope of work and have flexibility in determining deliverables.
• The experience spans two semesters (vs. something shorter like one semester or a summer).
• Students have ample time during their assigned class time to make progress on their projects.
• Course assignments (e.g., workplan, team charter, weekly updates) provide “guardrails” for the project experience to help ensure mutual benefit.
• There are robust staffing supports in place to recruit and maintain community partnerships, minimize community partners' burdens, and maximize student learning. Such supports are especially important when students have nascent project management skills and limited professional experience ( 10 , 13 ).

As shown in Figure 1 , program staff work on Capstone activities year-round and recruit new community partners while managing a current cohort of preceptors. Clear job descriptions with timelines will be helpful in negotiations and will assist with sustainability as different faculty and staff cycle through leading this kind of experience.

Our description and analyses have many strengths. First, the detailed and transparent information contained in this paper will allow interested faculty to replicate and benefit from best practices found in Capstone. We openly share our course materials in the Supplementary material section and invite others to adopt or adapt these resources for their own use. Second, our results illustrate the benefits of Capstone and highlight mechanisms for ILEs to be transformative for students and community partners alike. Lastly, all authors on this paper have been members of the Capstone teaching team, students enrolled in the course, or both. This uniquely qualifies us to write this paper and share lessons learned with others in the field to advance public health training and practice.

Limitations

As noted above, our evaluation of Capstone has some limitations. First, we designed our evaluation and analyzed data retrospectively. Therefore, evaluation tools were not explicitly aligned to our four program objectives or the elements of critical service-learning. Second, we narrowed in on qualitative data from the past 2 years instead of the past 13 years because of changes implemented in 2020. To present reflections and feedback on the current version of Capstone, we had limited data to analyze.

By applying elements of critical service-learning to an ILE, Capstone is uniquely positioned to contribute to the development of public health leaders and positive community change. Community partners' project visions undergird the project selection and the course structure, which emphasizes authentic relationships, mutually beneficial processes, and practical synthesis of applied public health competencies. Through 13 years of experience, we have developed an ILE that is nimble enough to benefit community partners and rigorous enough to satisfy accreditation requirements. Capstone is a promising culminating experience practice for training skilled, collaborative public health practitioners and effecting community-driven public health change.

Data availability statement

Author contributions.

ML developed the course and its content along with peer colleagues, wrote the abstract along with the learning environment, program evaluation, and results sections. ML and LS conducted the thematic data analysis. MC and LS completed a literature review, drafted the introduction and pedagogical framework section, and provided continual editing. EC wrote the discussion section and provided overall guidance for manuscript preparation. DE provided guidance, structural editing, and formatting. BP provided line edits. All authors contributed to the conception of the paper, manuscript revision, read, and approved the submitted version.

Acknowledgments

We are grateful to the 579 students and seventy-nine community partners we have learned from and with over the past 13 years. Many thanks to the editors and reviewers of this article for their comprehensive and helpful feedback including Laura Linnan, Beth Moracco, Kelsey Accordino, and Naya Villarreal. This paper is dedicated to the memory of Jo Anne Earp.

Conflict of interest

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Publisher's note

All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.

Supplementary material

The Supplementary Material for this article can be found online at: https://www.frontiersin.org/articles/10.3389/fpubh.2023.1129330/full#supplementary-material

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Medical College of Wisconsin MPH Program - Capstone Project Abstracts and Presentations

Abstracts and presentations.

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Translating Trauma-Informed Care from The Community to The Clinician: A Community-Informed, Strengths-Based Approach to Asking About Trauma [email protected] Advisor: Hillary Petska, MD, MPH Abstract Background/Hypothesis/Objective(s) Exposure to adverse childhood experiences (ACEs) is a major public health problem. ACEs can lead to childhood toxic stress and negatively impact health and well-being. National organizations have advised that providers discuss childhood adversity and its impact with children and families. However, little is known regarding patients’ perspectives on ACEs, or their preferences on discussing these topics in the medical setting. This study addresses these gaps by adding the voices of adults from a community with a heavy burden of ACEs. Methods Design: Descriptive qualitative study. Setting: Three Federally Qualified Health Centers (FQHC) in Milwaukee, WI. Recruitment: English- or Spanish-speaking adults were recruited from health center waiting rooms and interviewed. Participants: 37.5% African-American, 50% Hispanic, 12.5% Caucasian, 55% female, ages 18-35 (mean 43), 70% parents, and 75% from poorest zip codes. Data Collection: Interview elicited responses about the impact of stress on individuals and families; preferences and recommendations for discussing adults and their children’s ACEs; and barriers and facilitators of disclosing ACEs. 31 interviews were audio-recorded and transcribed. 9 interviewees declined recording; those interview notes were transcribed after the interview. Data Analysis: Transcriptions were analyzed with an iterative coding process and thematic analysis. Results Five themes emerged.

• Stress adversely affects parenting and children.
• Benefits include getting help for themselves and their children, receipt of resources and feeling less alone.
• Barriers to disclosure include judgment and mistrust.
• Providers should ask patients about ACEs and strengths and can overcome barriers by establishing rapport and building trust.
• Providers should frame discussions of ACEs, utilize a variety of approaches for starting conversations, and be transparent about reporting responsibilities.

Discussion Providers whose practices reflect patients’ preferences may facilitate disclosure of adversity, identify strengths, and prevent negative health consequences and promote resilience.

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The Importance and Challenges Associated with Recruiting African American Donors for Blood Donation in the United States Advisor: Kim Gearin, PhD Abstract Objective The purpose of this paper is to enhance understanding of the importance, challenges, and strategies associated with recruiting African American donors for blood donation in the United States. Methods  This literature review analyzed 14 studies related to African American blood donation conducted within the last 30 years. Results: From these studies, it was determined that several barriers prevent African Americans from donating blood. Notable barriers include lower donation eligibility rates and increased rate of deferrals, different motivators and deterrents to donating, and lower hemoglobin levels as compared to Caucasian donors. This paper also discusses strategies to increase African American blood donation, such as new marketing strategies, and hemoglobin education programs aimed specifically at African American donors.

Conclusions These findings demonstrate the need to further explore what prevents African Americans from donating blood and explore various strategies that may increase donation rates.

PowerPoint Presentation (PDF)

Multi-domain Evaluation of Concussion Management, Practice Patterns, and Resource Utilization Among Wisconsin Athletic Trainers [email protected] Advisor: Michael McCrea, PhD

Abstract Background Sport-related concussion (SRC) is a significant public health concern which effects as many as 1.6–3.8 million people each year.  Athletic trainers (ATs) are uniquely suited to address the challenges associated with SRC and may help reduce or prevent its impact.  Current guidelines recommend a multifaceted (i.e., more than two) approach to assessment at baseline, acute assessment, and return-to-play (RTP).  Previous national and state-level investigations do not adequately reflect regional differences in practice patterns due to variations in legislation and policy.

Purpose The purpose of this project is to evaluate the current awareness and utilization of resources and practice patterns related to SRC management and education among Wisconsin ATs.

Methods A 55-item questionnaire was disseminated through email and social media to over 900 Wisconsin ATs in early 2018.  Survey questions were intended to assess respondent clinical and educational practice patterns, and demographics and professional experience.

Results A total of fifty-two ( n = 52) survey responses were collected from Wisconsin Athletic Trainers’ Association (WATA) members for an estimated response rate of 7.6% (52/680 certified members).  Respondents were typically between the ages of 35 to 44 with 11 to 15 years of experience.  ATs in Wisconsin indicated using multiple guidelines (84%) for SRC management and generally employed a multifaceted approach to concussion assessment (94%) and RTP (82%), but not at baseline (22%).  A minority (12%) of ATs indicated that they conducted no baseline assessments.  Computerized neuropsychological testing was the most common assessment at baseline (86%) with a symptom checklist most frequently used acutely (96%) and at RTP (92%).  Resource access was considered adequate by most ATs (92%), but a significant minority reported by feeling overwhelmed by number available (34%).  A sizeable proportion of ATs also felt that improvements could be made to athlete (46%), coach (51%), and parent (51%) education.  Although the sample size was relatively limited, practice patterns were not found to significantly vary based on gender, practice setting, or years of experience.

Conclusion Wisconsin ATs have largely complied with current SRC guidelines for injury assessment and management but may not have the necessary resources (i.e., time, personnel, or funding) to provide multifaceted assessment at baseline.  Additionally, ATs generally feel well informed but indicate that there may be significant gaps in athlete, parent, and coach education. 

Infant and Early Childhood Risks and Services Assessment of Wisconsin Counties [email protected] Advisor: Kaija Zusevics, PhD

Abstract This report is a statewide, county-level needs assessment of select risks to healthy development facing children under the age of five across Wisconsin. This assessment identifies the counties whose children are at the greatest and lowest risk of negative developmental outcomes based on eleven health, safety, and economic indicators. An overall risk score is calculated by combining the results from these risk indicators. Eight counties are identified as being at the highest risk level, and eleven counties are found to be at the lowest risk, but vulnerabilities and strengths exist within each county. Additionally, the current availability and utilization of five programs aimed at improving outcomes for this age group are examined in relation to the overall level of risk faced by children in each county. This information is meant to inform conversations regarding how to best meet the developmental needs of Wisconsin’s youngest and most vulnerable population.

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Social Stigma and Substance Use Patterns Among Women: A Review [email protected] Advisor: Kim Gearin, PhD Abstract Objective Stigma is a product of social interaction and identity management. It is found to have profound effects on health outcomes, particularly for women who use illegal drugs. This paper will draw on Goffman’s theory of stigma to examine how stigmatization frames social perceptions of substance abuse, addiction and treatment in scientific literature and mainstream media.

Methods Sixteen journal articles and 30 magazine articles were selected and examined to identify and analyze references to women, stigma and opioids. A summary of findings from the literature review is organized into three categories: stigma and addiction, stigma and treatment and stigma, and the criminal justice system.

Results This qualitative review found differing attitudes toward women who use opioids. The mainstream media tends to have a more understanding perspective, acknowledging opioid addiction as a mental health condition deserving of fair treatment. Whereas the most common protocols in the criminal justice system bar women from receiving referrals to appropriate treatment programs, thereby perpetuating stigma.

Conclusion Despite recent changes to how opioid use and addiction are understood, the history of opioid use as inherently criminal continues within the criminal justice system. The differing opinions of how opioid use should be addressed in the United States creates inconsistency in treatment approach and continues to perpetuate stigma. To reduce the burden of stigma on women who use, the United States’ criminal justice system and drug treatment courts should adopt policies that promote best-practice treatment standards and recognize opioid use/addiction as a mental health concern.

Quality Improvement Project Using Assessment Feedback Incentives Exchange to Increase Human Papillomavirus Immunization Rates [email protected] Advisor: Kim Gearin, PhD

Abstract Background The Assessment, Feedback, Incentives, and eXchange (AFIX) Program applies quality improvement (QI) to increase vaccination rates in the Vaccines for Children (VFC) program. To improve adolescent human papillomavirus (HPV) vaccination rates, AFIX site visits were conducted at VFC clinics in Wisconsin in 2015.

Objective To assess effectiveness of an HPV AFIX project by examining whether 1) participating clinics implemented their QI strategies, 2) providers strengthened their HPV vaccine recommendations, 3) clinic immunization staff engaged in QI, 4) participating clinics wanted additional support, and 5) HPV vaccination rates and missed opportunities changed more at participating clinics compared to control clinics.

Methods HPV AFIX site visits (187) were conducted at self-selected VFC clinics during 2015 and 2016. At these visits immunization rates, practices and strategies to improve HPV immunization rates were evaluated. The Wisconsin Immunization Registry (WIR) was used to provide data for 11-18 years olds, for one dose of tetanus, diphtheria, acellular pertussis vaccine ( Tdap), one dose of meningococcal vaccine (MCV4), and one (HPV1) and three doses (HPV3) vaccines. Missed opportunities (any contact a patient has with a health service that did not result in an eligible child receiving recommended vaccines) were also assessed. Control clinics were chosen based on population size and geographical proximity to participating clinics.

Results  For both age groups, HPV1 and HPV3 rates increased at control clinics and AFIX clinics. Compared to control clinics, the increase at participating clinics was not statistically significant. Compared to control clinics, there was a statistically significant reduction in missed opportunities at AFIX for both age groups at six months. Findings suggest that many clinics engaged staff and completed QI projects, and some clinics wanted additional support.

Conclusion AFIX should be used by all clinics to increase uptake and awareness of the HPV vaccine in adolescents.

Assisted Living in Wisconsin: An Analysis of the Relationship Between Enforcement Data and Client Groups Served [email protected] Advisor: Kim Gearin, PhD

Abstract Background Wisconsin leaders have described assisted living homes in Wisconsin as operating as “mini-nursing homes” but with far less resources. This is not surprising, given the substantial increase in the number of assisted living facilities and equal decrease in skilled nursing facilities. The Wisconsin Department of Health Services reports an increase in serious regulatory concerns, especially within Community Based Residential Facilities. These facilities may serve residents from one to ten client groups. Given the rapid growth, increased needs of residents, and serious quality issues, the relationship between client groups served and regulatory measures recorded should be examined.

Methods A literature review for existing data on serving different client groups in one facility and regulatory best practices in assisted living. Then, enforcement data provided by the Wisconsin Department of Health Services on Community Based Residential Facilities to examine the relationship between client groups served and enforcements.

Results Facilities that serve residents with irreversible dementia/Alzheimer’s and advanced age accounted for a disproportionate share of enforcements. They also had the highest percentage of facilities with key code enforcements. An unexpected finding of this study was the lack of data collected and reported by the state, as well we the significant backlog of surveys not conducted by the departments target.

Conclusion These findings raise important issues and point to an alarming pattern of increased enforcement citations at CBRFs that serve specific client groups, especially irreversible dementia/Alzheimer’s. Urgent action and additional research is needed, which would be best initiated through an external legislative audit.

Cancer Disparities Among Asian-Americans [email protected] Advisor: Kaija Zusevics, PhD

Abstract Background Cancer is the leading cause of death among Asian Americans compared to heart disease for other racial groups. Several barriers exist that preclude this racial group to cancer screening and early detection. This study aimed to describe the cancer disparities among the different subgroups of Asian Americans and the evidence-based and culturally-tailored interventions to reduce their cancer burden.

Methods Literature review was performed to analyze the trend of cancer among Asian Americans. Physicians in the Inland Empire region of Southern California were recruited to participate in individual interviews (n=8) to assess their opinions about cancer in this racial group. The medical providers from various specialties belong to medical groups, public, and private practice.

Results Literature review: Four articles described cancer trends among Asian Americans. The data revealed the extent of heterogeneity and variation of cancer morbidity and mortality among the U.S. Asian subgroups. The most common malignancies include prostate, breast, colorectal, and lung.  There is also a higher incidence of infection-related cancers including liver, nasopharyngeal, and stomach malignancies compared to other racial groups.

Physician interviews: Lifestyle patterns including poor diet, obesity, and smoking were the most commonly identified risk factors for the heavier cancer burden in this group. Several barriers to care including lack of access to health insurance and language and cultural barriers were reported. Physicians’ time limitation during clinic visits was an unexpected response. Most physicians agreed that collaboration between health care and public health must occur to improve cancer awareness and screening.

Conclusion Promotion of cancer awareness, screening, and early detection among Asian Americans is of utmost priority to decrease disease cancer rates. Addressing the multiple barriers will reduce cancer disparities in this racial group. Further research is needed to investigate the impact of cancer on underrepresented subgroups and the cultural determinants of cancer among young Asian Americans.

Reducing Childhood Asthma Exacerbations Advisor: Kristen Volkman, MD

Abstract Background Childhood asthma is the most common chronic illness in the pediatric population, affecting thousands of children across the nation. Asthma triggers found in a variety of locations increase asthma exacerbations, hospitalizations, and mortality and morbidity. Prevention techniques should be utilized to reduce and/or eliminate asthma triggers and improve the quality of children’s lives.

Objective To describe common asthma triggers found in a variety of environments and prevention techniques to reduce and/or eliminate their presence.

Methods Five scientific articles were reviewed to determine the most common asthma triggers found in homes, child care centers, and schools. Prevention techniques were also identified from these articles as well as other sources.

Results   Asthma triggers that can be found in homes, child care centers, and schools include tobacco smoke, dust mites, outdoor air pollution, pests, pets, mold, and strong odors. Many prevention methods were identified, such as removal of carpeting, smoking cessation, effective cleaning methods, and repairing water incursion.

Conclusion If prevention techniques of common asthma triggers were utilized, positive outcomes, such as decreased asthma exacerbations, decreased missed school days, decreased hospitalizations, and decreased mortality and morbidity of children can be achieved.

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The Opiate Impact on Southeastern Wisconsin Communities [email protected] Advisor: Eric Gass, PhD

Abstract Background Opioid related deaths have become a growing epidemic in Wisconsin. A steady increase has been documented throughout the state from 2000 to 2016, increasing from 111 deaths in 2000 to 827 deaths in 2016. While the entire state has seen an overall increase, no county has been hit harder than Milwaukee County. Between the years of 2003 and 2013, opioid overdose increased in Milwaukee by 600%. Between the years of 2012 and 2016, Milwaukee County had a documented total of 967 opioid related deaths.  One of the biggest contributors to the increase of opioid related overdoses and deaths is the drastic increase in prescriptions for pain killers that are being written and dispensed to patients. In 2013, nearly 207 million prescriptions were written for opioids, and in 2016, prescribing rates were so high that in a quarter of U.S. counties, there were enough prescription opioids prescribed for each person to have one.

Objective To establish the best evidence-based practices of lessening the burden of opioid related overdoses and death.

Methods A literature review and analysis was conducted through an online search of databases and government websites including: Google Scholar, PubMed, National Institute of Health and Centers for Disease Control and Prevention. The database searches were completed using the following search terms: prescription drug monitoring, PDMP success, naloxone, opioid prevention, medication-assisted therapies, drug take back, opioid epidemic state success and opioid policies.

Results  Studies suggest that the most successful programs included improving and requiring the use of prescription drug monitoring programs, development of medication assisted therapies, creating new state policies, and establishing drug take back programs are proven ways to create the highest level of success. In addition, states with success have also begun requiring opioid prevention programs into school curriculum to promote awareness.

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The Culminating Experience must be completed in the last semester of the Master of Public Health (MPH) program at the UGA College of Public Health. More commonly known as the Capstone Project,  the Culminating Experience provides comprehensive documentation of the student’s comprehension of the MPH Core Competencies. It also serves as the UGA Graduate School’s non-thesis equivalent of the mastery of a student’s academic discipline.

Students must be enrolled in PBHL 7800 during the semester they undertake their Capstone Project.  They cannot enroll in this class for more than ONE semester, or undertake more than three academic credits.

For more information about the MPH Capstone Project, please refer the Capstone Manual relevant to your year.  Additional materials, such as the Capstone registration form and sample capstones can be found below.

Winners of our Exceptional MPH Capstone E-Presentation Award for 2021:

• Kyle Patel – Gun Ownership and Bereavement by Suicide: Race, Gender, and Age – Advisor: Toni Miles
• Rochelle Obiekwe – The Relationship Between Sex and Stigma Among TB Patients in Uganda – Advisor: Juliet Sekandi
• Clay Royster – Predicting the number of opioid-related inpatient stays with Medicaid as the primary insurance payer using an autoregressive integrated moving average (ARIMA) model in Georgia, USA – Advisor: Ming Zhang
• Ansley Kasha – A‌ ‌Survey‌ ‌of‌ ‌Attitudes‌ ‌of‌ ‌College‌ ‌Students‌ ‌Regarding‌ ‌the‌ ‌Voluntary‌ ‌Installation‌ ‌of‌ ‌a‌ ‌Breathalyzer‌ ‌in‌ ‌a‌ ‌Personal‌ ‌Vehicle‌ – Advisor: Carol Poe
• Dionne Mitcham – Utilizing Social Media for Information Dispersal during Local Disasters: The Communication Hub Framework for Local Emergency Management – Advisor: Curtis Harris
• Victoria Fonzi – Planning for future COVID-19 vaccine distribution using influenza vaccination location data from the 2018 Behavioral Risk Factor Surveillance System (BRFSS) – Advisor: Janani Thapa

Winners of our Exceptional MPH Capstone Paper Awards for 2021:

• Lily Rubin – Interventions to Increase Colorectal Cancer Screening Adherence in Low-Income Settings: A Systematic Review – Advisor: Mark Ebell

Winners of our Exceptional MPH Capstone E-Presentation Award for 2020:

• Analysis of COVID-19 in long term care facilities in The United States – Avery Duncan , BS/MPH in Epidemiology
• Slow and Steady Wins the Race: Examining Participant Engagement in Telephone and Group Health Coaching in the Fuel Your Life Program- Julia Hennig , MPH in Health Promotion and Behavior
• Mobile Phone Use and Depressive Symptoms Among College Students in Uganda – Samantha Jackson , MPH in Epidemiology
• The Effects of Childhood Financial Stress on Adult Chronic Disease – Grace Marie Smith , MPH in Epidemiology

Winners of our Exceptional MPH Capstone Paper Awards for 2020:

• Robot-led piano lessons improve cognitive function: A feasibility study in a sample with mild cognitive impairment – Bailey Collette, MPH in Health Promotion and Behavior
• The Public Economic Consequences of Nonmedical Use of Prescription Opioids in United States Adolescents Attributed to Morbidity and Premature Mortality – Nikki Fillingim , MBA/MPH in Health Policy and Management
• Micronutrient Deficiencies in Belizean Preschool-aged Children: Belize National Micronutrient Survey 2011 – Clarissa Keisling , MPH in Epidemiology
• Providing On-Site Continuing Education to Georgia Long-Term Care Facility Direct Care Workers and Assessing Post-Training Attitude Change: A Feasibility Study – Annie Ndolo , MPH in Epidemiology
• A review of emergency medical services vulnerabilities to highly infectious disease – Thomas Richey , MPH in Disaster Management

Winners of our Exceptional MPH Capstone E-Presentation Award for 2019:

• “Swipe Right & Unite for HIV Prevention: Dating Application Use Among Rural MSM” – Lauren Bineau , MPH in health promotion and behavior
• “Pregnancy, stress and social support during Hurricane Florence” – Victoria Jackson , MPH in health promotion and behavior
• “Outcomes of “Swiping Right”: Sexual Risk Behaviors of Undergraduate Tinder Users” – Alexis Whitmire , MPH in health promotion and behavior

Winners of our Exceptional MPH Capstone E-Presentation Award for 2018:

• “Does BASELINE CD4 Count PREDICT Symptoms Related to Mental Illness In HIV Infected Patients?” – Christopher Bland , MPH in epidemiology
• “Risk of Brucellosis, Tularemia, and Chronic Wasting Disease in US Hunters: A Systematic Review” – Devann Kirkpatrick , MPH in epidemiology
• “Disaster Preparedness Practices Among Puppy Raisers” – Shelby Naar , MPH in disaster management
• “Application of UAVs in Radiation Detection” – Sai Nagula , MPH in disaster management

Capstone Manuals

Capstone (Integrated Learning Experience) Manual 2020-21

Capstone Manual 2019-20 (latest update 3.23.20) Capstone Manual 2018-19 Capstone Manual 2017-18 Capstone Manual 2016-17 Capstone Manual 2015-16 Capstone Manual 2014-15 Capstone Manual 2013-14

Capstone Registration Form (latest update 3.23.20) Capstone Sample Rubric Capstone Sample Signature Page

Sample Capstones

Biostatistics Sample 1-Paper Sample 1-Poster

Disaster Management Sample 1-Paper

Environmental Health Sample 1-Paper Sample 1-Poster

Epidemiology Sample 1-Paper Sample 1-Poster Sample 2-Paper Sample 2-Poster

Gerontology Sample 1-Paper

Health Policy & Management Sample 1-Paper Sample 1-Poster

Health Promotion and Behavior Sample 1-Paper Sample 1-Poster Sample 2-Paper Sample 2-Poster

MPH Student Handbook Archive:

2021-22 MPH Student Handbook

2020-21 MPH Student Handbook 2020-21- MPH Field Placement Handbook 2019-20 MPH Student Handbook 2019-20 Field Placement Handbook 2018-19 MPH Student Handbook 2018-19 MPH Field Placement Handbook 2017-18 MPH Student Handbook 2017-18 MPH Field Placement Handbook 2016-17 MPH Student Handbook 2016-17 MPH Field Placement Handbook 2015-16 MPH Student Handbook 2015-16 MPH Field Placement Handbook

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Colorado School of Public Health at Colorado State University

Colorado state university.

For MPH students, the culminating academic experience is a capstone project that benefits the community or a particular target population. Our MPH students do not complete a thesis.  Capstone projects contribute meaningfully to the current body of knowledge in the field and may include, but are not limited to, creating a program plan or evaluation, summarizing data findings, developing policy recommendations, designing an online tool, teaching health education classes, and many other possibilities.

As with the practicum, capstone projects can be completed anywhere in the world and students work with assigned faculty advisors to plan out an appropriate capstone project. See the button below for a listing of potential host sites.

The goal of the capstone project for the MPH student is to connect all aspects of the curriculum, including seminars, lectures, course work, projects, and practical experiences. Students establish an understanding and appreciation for how their concentration enhances public health practice opportunities in Colorado, the nation, and the world.

Capstone Video Series

• #1 What is the MPH capstone?
• #2 What are the capstone prerequisites and requirements?
• #3 How to prepare for your capstone and find a host site
• #4 How to develop and receive approval for your capstone proposal
• #5 How to successfully complete your capstone project
• #6 How to prepare your capstone poster
• #7 How to prepare your capstone presentation
• #8 How to write your capstone paper

The capstone project, with final products of a paper and professional oral and poster presentation, relates to the student’s academic goals and professional interests, and demonstrates their ability to work independently at the master’s level.  At the end of each semester, the students who have completed their capstone project give an oral and poster presentation at our Public Health Forum.

Capstone advisors

While completing the capstone project through CSU, students enroll in a two-credit capstone course and are assigned a faculty advisor for ongoing support and guidance throughout the process. Capstone advisors are:

Kendra Bigsby

Dr. Tracy Nelson

Dr. Molly Gutilla

Dr. Olivia Arnold

Dr. Umit Shrestha

University of Washington

Health Systems and Population Health

School of public health.

• Community-Oriented Public Health Practice Master of Public Health
• Academic Experience
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Leading the Change for Healthier Communities

2 years / full time / seattle, wa.

The University of Washington Community-Oriented Public Health Practice Master of Public Health (COPHP MPH) program prepares you to become a problem solver, leader, and advocate in the field of community health.

The COPHP MPH program is offered by the UW Department of Health Systems and Population Health (HSPop) housed in the UW School of Public Health and administered in partnership with the UW Continuum College.

Take an Active Learning Role

Our problem-based learning approach cultivates a student’s ability to identify key public health issues, deconstruct problems via intersectoral collaboration, and present solutions clearly and persuasively to different audiences.

Improve Community Health

Learn the skills and competencies to be successful in assessing population health needs, addressing social structures that create health disparities, and working with communities to implement successful public health programs.

Gain Real-World Experience

Develop effective skills in the field of public health during your practicum, and apply advanced public health competencies during a capstone project.

Promote Health Justice

Commit to collaborating with communities to undo structural inequities and improve health justice at the community, organizational, and systemic levels.

Application Dates

2025 Cohort Application Opens September 1, 2024

Deadline January 15, 2025

2024 Cohort: Limited space is still available! See instructions.

Information Sessions

Prospective COPHP MPH students can register for and attend an information session to learn more about the program.

Alumni Connections

COPHP MPH alumni can stay connected, learn about what their peers are doing, and support future public health professionals, , including serving as practicum and capstone supervisors to students.

Stay Up-to-Date

Considering the Community-Oriented Public Health Practice Master of Public Health (COPHP MPH) program? Sign up to receive email updates about upcoming application deadlines and more.

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Support students.

Make a difference for COPHP MPH students by giving to the Sigolène Ortega Fund for Social Justice in Public Health. Support future public health leaders today!

Master of Public Health 

The chinese university of hong kong, capstone project objectives.

In order to fulfill their requirements for graduation, all MPH students are required to undertake a final Capstone Project, culminating in a written report. Each student is required to develop and complete an individual project of a public health problem, under the direction of a supervisor in their selected concentrations at the School. The topic of each project should be relevant to the concentrations selected by the students and the supervisors will be assigned accordingly.

Upon satisfactory completion of the Capstone Project, all the students should be able to:

conduct a proper literature review on a public health issue;

develop a research protocol or practicum-based project plan;

have practical, hands-on experience in the form of research or public health practice;

perform data analysis or a systematic evaluation of a public health issue or evaluation of a project;

write a manuscript using standard journal format or an official report using institutional format;

orally present their work at a professional level; and

create a professional poster for presentation at public health conferences.

Research-based

Students may elect to undertake a Research-based Capstone Project where they conduct primary data collection and analysis, analysis on secondary data, policy analysis, cost-benefit analysis, rigorous literature review for policy analysis, systematic reviews, needs assessment and programme evaluation.

Practice-based

Students may also elect to undertake a Practice-based Capstone Project where they identify a public health problem or issue and implement a public health-related programme to address this problem. Practice-based projects require that students locate a suitable setting for approximately 120 hours (about 3 weeks FT equivalents) in the field in order to conduct programme implementation or programme enhancement.

Selected Publications

Cheung K, Chan V, Chan S, Wong MMH, Chung GKK, Cheng WY, Lo K, Zeng F (2024). Effect of Intermittent Fasting on Cardiometabolic Health in the Chinese Population: A Meta-Analysis of Randomized Controlled Trials. Nutrients 2024 , 16, 357. 

https://doi.org/10.3390/nu16030357

Wong J, Chan KY, Lo K (2021). Sodium glucose co-transporter 2 inhibitors on weight change and cardiometabolic profiles in individuals with overweight or obesity and without diabetes: A meta-analysis. Obesity Reviews . 2021;e13336. doi:10.1111/obr.13336

Chan KY, Wong M, Pang S, Lo K (2021). Dietary supplementation for gestational diabetes prevention and management: a meta-analysis of randomized controlled trials. Arch Gynecol Obstet , available online. 2021.03 doi:10.1007/s00404-021-06023-9

Sze YP, Lee KP, Chan HW, Kim JH (2021).  Prevalence of negative emotional eating and its associated psychosocial factors among urban Chinese undergraduates in Hong Kong: a cross-sectional study.  BMC Public Health , 21(1):583. 2021.03 doi:10.1186/s12889-021-10531-3

Lee KP, Lau EY, Sumerlin TS, Kim JH (2019).  Urban Chinese midwives' knowledge, attitudes and practices toward umbilical cord blood donation.  Midwifery , 69:59‐66. 2019.02. doi:10.1016/j.midw.2018.10.017

Chan MH, Wang F, Mang WK, Tse LA (2018).  Sex Differences in Time Trends on Incidence Rates of Oropharyngeal and Oral Cavity Cancers in Hong Kong.  Annals of Otology, Rhinology, and Laryngology , 127(12):895‐902. 2018.09. doi:10.1177/0003489418802287

Hu CX, Abraham A, Mitra AK, Griffiths SM (2016). The benefits of experiential learning in global public health.  Public Health, 136:196‐199. 2016.07.  doi:10.1016/j.puhe.2015.10.030

Ding YJ, Lau CH, Sou KL, Abraham AA, Griffiths SM, Kim JH (2016). Association between internet addiction and high-risk sexual attitudes in Chinese university students from Hong Kong and Macau.  Public Health , 132:60‐63. 2016.03. doi:10.1016/j.puhe.2015.11.009

Keller JJ, Kim JH, Lau JC, Wong AH, Griffiths SM (2014). Intention to engage in preventive behaviors in response to the A/H1N1 pandemic among university entrants in four Chinese cities.  Asia Pac J Public Health , 26(1):42‐47. 2014.01. doi:10.1177/1010539513496842

Ho HS (2012). Use of face masks in a primary care outpatient setting in Hong Kong: Knowledge, attitudes and practices.  Public Health , 126(12):1001‐1006. 2012.12. doi:10.1016/j.puhe.2012.09.010

Rodas JR, Lau CH, Zhang ZZ, Griffiths SM, Luk WC, Kim JH (2012). Exploring predictors influencing intended and actual acceptability of the A/H1N1 pandemic vaccine: a cohort study of university students in Hong Kong.  Public Health , 126(12):1007‐1012. 2012.12. doi:10.1016/j.puhe.2012.09.011

Law T, Kim JH, Lee KY, Tang EC, Lam JH, van Hasselt AC, Tong MC (2012). Comparison of Rater's reliability on perceptual evaluation of different types of voice sample.  J Voice ,  26(5):666.e13‐666.e6.66E21. 2012.09. doi:10.1016/j.jvoice.2011.08.003

Quartey NK, Ma PH, Chung VC, Griffiths SM (2012). Complementary and alternative medicine education for medical profession: systematic review.  Evidence-Based Complementary and Alternative Medicine , 2012:656812.  2012.04. doi:10.1155/2012/656812

Suen SS, Lao TT, Chan OK, Kou TK, Chan SC, Kim JH, Lau TK, Leung TY (2011). Maternal understanding of commercial cord blood storage for their offspring - a survey among pregnant women in Hong Kong. Acta obstetricia et gynecologica Scandinavica, 90(9):1005‐1009. 2011.09. doi:10.1111/j.1600-0412.2011.01201.x

Hung KK, Chan EY, Cocks RA, Ong RM, Rainer TH, Graham CA (2010). Predictors of flight diversions and deaths for in-flight medical emergencies in commercial aviation.  Arch Intern Med, 170(15):1401‐1402. 2010.08. doi:10.1001/archinternmed.2010.267

Go ETT, Goggins WB (2009). Comparison of the glycemic control of the normo- and hypertensive Chinese patients with type 2 diabetes in a general outpatient clinic in Hong Kong. Diabetes and Metabolic Syndrome: Clinical Research and Reviews , 3:29-34. 2009.03. doi:10.1016/j.dsx.2008.10.012.

Cheung LP, Ma RC, Lam PM, Lok IH, Haines CJ, So WY, Tong PC, Cockram CS, Chow CC, Goggins WB (2008). Cardiovascular risks and metabolic syndrome in Hong Kong Chinese women with polycystic ovary syndrome.  Hum Reprod, 23(6):1431‐1438. 2008.06. doi:10.1093/humrep/den090

• Public Health-Global Health Major
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Public Health Capstone

The Public Health Capstone is intended to be an integrative service-learning experience in which students bring together much of the  competencies and skills  acquired during their time in the Public Health Major and in college. The capstone will count as 5 credits and a minimum grade of 2.0 is required.

A recent student shared this about Capstone :   “SPH 491/492 class has honestly been my favorite class I've taken at UW! [This] made me more aware of a population I had never worked with, it gave me the opportunity to apply skills I had learned as an undergrad, and helped me understand how to assess and address a public health problem.”

The Capstone integrates previous knowledge, applies it in a real world setting, and helps develop skills such as cultural competency and civic responsibility as students seek to identify, assesses, and address public health problems.

In Capstone, students engage in a service-learning experience, a literature review, reflections, a synthesis paper, and a presentation.

Students may register for the following options to complete their Capstone:

• SPH 496 – one 5-credit course completed in one quarter; offered AUT & WIN quarters
• SPH 491 & SPH 492 – two courses, total 5 credits, completed in two quarters requiring enrollment in the same discussion section across quarters; SPH 491 is offered in WIN quarter for 2 credits, and SPH 492 is offered in SPR quarter for 3 credits
• Grand Challenges Impact Lab: India – one quarter study abroad, 5 credits may be applied to meet the Capstone requirement; offered WIN quarter
• Grand Challenges Impact Lab: Seattle – one course, total 5 credits; offered SPR quarter

The service-learning component, which is a community based, real-world experience completed in small groups and will be arranged ahead of time by the course instructor. The service-learning sites are predominantly direct service organizations that support efforts to address a wide range of public health issues such as homelessness, food insecurity, access to health care, educational opportunity gaps, recent immigrant and refugee services, housing and many more.

Service-learning sites in recent quarters have included the following:  The American Heart Association, Bailey-Boushay House, Chinese Information and Services Center, Cleveland High School, East African Community Services, HS3 High School in the Highline District, KC Juvenile Detention Center, Mary's Place, Noel House, Planned Parenthood, Votes NW, Redmond High School, Refugee Women’s Alliance, Seattle Public Library, Teen Feed, Union Gospel Mission, United Way of King County, Urban Rest Stop, the Vulnerable Populations Strategic Initiative, and Within Reach.

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INFORMATION FOR

• Prospective Students
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• myYSPH Members

Yale School of Public Health (YSPH) has long emphasized both data science and data-driven health leadership. Equitable data science makes transformational and impactful research possible, resulting in innovations that advance and improve public health, from identifying new cancer treatments to creating guidelines reducing pollution’s health impact.

A new two-part gift to YSPH builds on this fundamental focus on data, while supporting an ongoing, collaborative educational program with the Yale School of Management (SOM). The gift, from former PepsiCo CEO Indra Nooyi, a 1980 graduate of the Yale School of Management, and her husband Raj Nooyi, will advance the school’s efforts to train students as leaders in data-driven public health improvement of people’s wellbeing at local, national, and global scales. The Nooyis have previously supported YSPH with an endowed professorship.

“I am so grateful to Indra and Raj for their strategic, farsighted support of these two important programs,” said YSPH Dean Megan L. Ranney. “We can’t be great public health data science leaders without investment – or without partnerships.”

Leading the Way with Data

“The Yale School of Public Health has a long record of accomplishment in data-driven, impactful research. During the COVID-19 pandemic, its researchers provided policymakers in Connecticut and internationally with timely data-driven insights to help guide emergency response. The school also educates future leaders who use public health data science and data equity to enable transformational research in the face of quickly changing methods, technology, and societal shifts,” says Indra Nooyi. “That track record was a significant factor in our decision to support the school.”

The Nooyis’ gift creates an endowed data science resource fund that can be used to advance teaching and research at the school. For example, recent research showed that RSV vaccines would decrease illness and death if deployed like flu shots and was used to develop a dynamic new tool for evaluating the effectiveness of large-scale public health interventions. In April, the school held an international gathering to improve equity in accessing and using high-quality health data. But as sources of data explode and artificial intelligence becomes more powerful, YSPH must expand its efforts to remain a leader in the field.

The Nooyis’ gift has enabled YSPH to recruit one of the world’s most influential public health data scientists. The school recently appointed award-winning statistician Bhramar Mukherjee, PhD, as its inaugural Senior Associate Dean of Public Health Data Science and Data Equity. The deanship, made possible by the Nooyis’ gift, is an important new leadership position that reflects the school’s focus on data science as a critical pillar for the future of public health. She joins YSPH on Aug. 1, 2024.

“Dr. Bhramar Mukherjee works at the cutting edge of public health data collection and analysis, with an eye towards global data equity,” Ranney said. “Her recruitment advances our goal of leading the future of public health data science.”

A Collaborative Degree

A portion of the Nooyis’ gift supports the continued success of the Health Care Management Program, run by YSPH and the Yale School of Management. Students take classes at both schools, earning a Master of Public Health (MPH) degree in healthcare management, and can pursue an MBA. Graduates of the program have become leaders of hospitals, public health systems, and health startups.

Howard Forman, a professor at both schools and a diagnostic radiologist at Yale New Haven Hospital, directs the program. “Our program is the best in the country, and the Nooyis’ support will help us remain financially affordable to students,” notes Forman.

One of the marquee events of the Health Care Management Program is a yearly conference that brings over 500 health care professionals to Yale SOM, including many of the program’s current students and alumni. The event celebrated its twentieth year in 2024. “The conference draws on academic rigor but emphasizes practice,” says Forman. “It’s a place where alumni and students can learn from each other.”

Ranney notes that YSPH is Yale’s newest independent school, transitioning from being a department of the Yale School of Medicine. “That means gifts like these have an outsize impact. Indra and Raj’s gift allows our school to continue to grow as world leaders of public health.”

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Sustainable Urban Planning Students Showcase Capstone Projects

Four spring 2024 graduates presented their Capstone Projects on May 10th to an enthusiastic audience at GW’s Arlington Education Center. The in-person event was open to students, alumni, faculty and the public, as well as live-streamed to far-flung families and friends.

The Capstone is the culminating experience for students in the master’s program in Sustainable Urban Planning (SUP) . Students complete individual projects to showcase the knowledge, skills and abilities they have learned. Students’ research projects are used to demonstrate mastery of the program’s key skills and knowledge. Students often share their capstone and studio projects with prospective employers and on LinkedIn to show that they can do professional-level planning work. Each capstone project has a specific audience who can use the student’s work to advance their goals.

"The capstone project is the culmination of each student’s experience in our program and the showcase is their opportunity to share that work with our community. I’m so proud of each of our spring graduates and their accomplishments."

Dr. Sandra Whitehead Program Director, Sustainable Urban Planning Program

Jason Kendall

Triple Bottom Line - Ecosystem Services with Native Plant Design

Native plants are uniquely adapted to local conditions and provide numerous ecological, social, and economic benefits compared to non-native species.  This work examines the advantages of using native plants in landscape design through the lens of the triple bottom-line framework: planet, people, and profit. Native plant landscapes support biodiversity, provide habitat for wildlife, improve soil health, reduce water consumption, and require less maintenance than traditional lawns and gardens.  Native plants also offer psychological and physical health benefits to people by reducing stress, improving air and water quality, and limiting exposure to harmful pesticides and fertilizers that lead to acute and chronic diseases. From an economic perspective, case studies demonstrate that the public has a high willingness to pay for native landscapes, and the reduced maintenance costs for water, fertilizer, and general upkeep make native plants an attractive alternative and cost-saving approach.  The insurance and financial sectors are beginning to recognize the risks of biodiversity loss and the value of ecological resilience that native plants provide. This work concludes that the evidence clearly shows native plant landscaping is beneficial for the environment, human well-being, and the economy. Policymakers, developers, and property owners should leverage these multifaceted benefits to accelerate the transition to more biodiverse, sustainable, and economically advantageous landscapes.

Joy McFadden

The Use of Adaptive Reuse to Fill Gaps in Early Childhood Education in Baltimore City, MD

 Adaptive reuse is a planning mechanism that allows planners to redevelop cities by transforming older buildings to meet the needs of current and future generations. One immediate need is the gap in access to affordable, sustainable childcare facilities and early childhood education centers. This is true in Baltimore, Maryland, where spatial analysis found several neighborhoods where less than 50% of the target population have access to childcare and experience built environments ill-disposed to walking. To tackle this issue, Baltimore can utilize its surplus of vacant properties and brownfields to create new green early childhood education centers to fill this gap in access. Other properties can be used to improve walkability in the built environment, making streets safer for children, providing connections between community institutions, and building mixed use beneficial for families. To accomplish this, Baltimore City should develop several key policies—an Adaptive Reuse Ordinance, a Childcare Master Plan, and updates to the “Whole Block, Whole Cities” initiative for vacant properties—that would highlight the importance of adaptive reuse as a tool.

Equity in Extreme Heat Adaptation: An Analysis of Two Cities’ Approaches

As the effects of climate change intensify and the global population becomes increasingly urbanized, extreme heat is becoming a growing threat for cities worldwide. This paper explores the extent to which two cities–Singapore and Freetown, Sierra Leone–have taken an equity-informed approach to their extreme heat adaptation planning. To answer this question, I examined publicly available documents detailing each city’s approach to heat adaptation. Based on a review of each city’s context, I identified vulnerable groups based on exposure and adaptive capacity, and then analyzed the extent to which equity was considered, using the four dimensions of distributive, procedural, recognitional, and reparative equity. My analysis found that neither city has a comprehensive heat adaptation plan or a stated approach to equity. Singapore’s response is largely technocratic, and does little to acknowledge the existence or work to target any vulnerable groups.  Freetown’s response reflects a more intentional approach to understanding and addressing the experience of heat for vulnerable populations, including the large proportion of residents who live in informal settlements. The findings of this analysis show that while cities have taken steps to address equity in extreme heat adaptation, more intentional efforts are needed to ensure that the unique experiences of vulnerable populations are adequately addressed.

Vanessa Walters

Economic Development Practices that Lead to Revitalization in the Finger Lakes

The Finger Lakes Region (NY) has continued to face issues related to industrial decline and economic changes throughout its history. When exploring the region, it is visible that there are many remnants of the economic prowess that once existed there. This research aims to understand the theories of change that will lead to revitalization in the Finger Lakes Region. After reviewing expert insight on regional development and community revitalization, toolkits for rural development, and case studies from around the country, best practices emerged. These best practices are broad but employ successful solutions for other areas across the country. From this, an additional case study review was performed. The comparative case study analysis reviewed four towns in similar situations as the study area across the Northeastern United States. These case studies in Eastport (ME), Poultney (VT), Mount Morris (NY), and Madison County (NY) discussed leveraging their historic economies and downtowns to move revitalization efforts forward in their communities. From further analysis, knowledge of the Finger Lakes Region, and understanding of the local economic drivers, Six Strategies for Economic Revitalization in Finger Lakes emerged. These strategies were then applied to Seneca Falls, Geneva, and Penn Yan. Within these applications, discussions around their local histories, assets, opportunities for future growth, and highlights of current projects were assembled to better understand the strategies in action.

"This year's posters and presentations were particularly inspiring, covering a range of topics from heat equity to native plants, re-development, and childcare inequity. Congratulations to Jason Kendall, Joy Mcfadden, Judy Chang and Vanessa Walters for completing this important milestone. I can't wait to see what you all achieve in the future!"

Dr. Liesl Riddle Dean, College of Professional Studies

The event was hosted by the Sustainable Urban Planning Student Organization (SUPSO). For more information about the Capstone process and SUPSO activities, visit the SUPSO website.  

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The White House 1600 Pennsylvania Ave NW Washington, DC 20500

FACT SHEET: Biden- ⁠ Harris Administration Announces New Principles for High-Integrity Voluntary Carbon   Markets

Since Day One, President Biden has led and delivered on the most ambitious climate agenda in history, including by securing the Inflation Reduction Act, the largest-ever climate investment, and taking executive action to cut greenhouse gas emissions across every sector of the economy. The President’s Investing in America agenda has already catalyzed more than $860 billion in business investments through smart, public incentives in industries of the future like electric vehicles (EVs), clean energy, and semiconductors. With support from the Bipartisan Infrastructure Law, CHIPS and Science Act, and Inflation Reduction Act, these investments are creating new American jobs in manufacturing and clean energy and helping communities that have been left behind make a comeback.

The Biden-Harris Administration is committed to taking ambitious action to drive the investments needed to achieve our nation’s historic climate goals – cutting greenhouse gas emissions in half by 2030 and reaching net zero by 2050. President Biden firmly believes that these investments must create economic opportunities across America’s diverse businesses – ranging from farms in rural communities, to innovative technology companies, to historically- underserved entrepreneurs.

As part of this commitment, the Biden-Harris Administration is today releasing a Joint Statement of Policy and new Principles for Responsible Participation in Voluntary Carbon Markets (VCMs) that codify the U.S. government’s approach to advance high-integrity VCMs. The principles and statement, co-signed by Treasury Secretary Janet Yellen, Agriculture Secretary Tom Vilsack, Energy Secretary Jennifer Granholm, Senior Advisor for International Climate Policy John Podesta, National Economic Advisor Lael Brainard, and National Climate Advisor Ali Zaidi, represent the U.S. government’s commitment to advancing the responsible development of VCMs, with clear incentives and guardrails in place to ensure that this market drives ambitious and credible climate action and generates economic opportunity.

The President’s Investing in America agenda has crowded in a historic surge of private capital to take advantage of the generational investments in the Inflation Reduction Act and Bipartisan Infrastructure Law. High-integrity VCMs have the power to further crowd in private capital and reliably fund diverse organizations at home and abroad –whether climate technology companies, small businesses, farmers, or entrepreneurs –that are developing and deploying projects to reduce carbon emissions and remove carbon from the atmosphere. However, further steps are needed to strengthen this market and enable VCMs to deliver on their potential. Observers have found evidence that several popular crediting methodologies do not reliably produce the decarbonization outcomes they claim. In too many instances, credits do not live up to the high standards necessary for market participants to transact transparently and with certainty that credit purchases will deliver verifiable decarbonization. As a result, additional action is needed to rectify challenges that have emerged, restore confidence to the market, and ensure that VCMs live up to their potential to drive climate ambition and deliver on their decarbonization promise. This includes: establishing robust standards for carbon credit supply and demand; improving market functioning; ensuring fair and equitable treatment of all participants and advancing environmental justice, including fair distribution of revenue; and instilling market confidence.

The Administration’s Principles for Responsible Participation announced today deliver on this need for action to help VCMs achieve their potential. These principles include:

• Carbon credits and the activities that generate them should meet credible atmospheric integrity standards and represent real decarbonization.
• Credit-generating activities should avoid environmental and social harm and should, where applicable, support co-benefits and transparent and inclusive benefits-sharing.
• Corporate buyers that use credits should prioritize measurable emissions reductions within their own value chains.
• Credit users should publicly disclose the nature of purchased and retired credits.
• Public claims by credit users should accurately reflect the climate impact of retired credits and should only rely on credits that meet high integrity standards.
• Market participants should contribute to efforts that improve market integrity.
• Policymakers and market participants should facilitate efficient market participation and seek to lower transaction costs.

The Role of High-Quality Voluntary Carbon Markets in Addressing Climate Change President Biden, through his executive actions and his legislative agenda, has led and delivered on the most ambitious climate agenda in history. Today’s release of the Principles for Responsible Participation in Voluntary Carbon Markets furthers the President’s commitment to restoring America’s climate leadership at home and abroad by recognizing the role that high- quality VCMs can play in amplifying climate action alongside, not in place of, other ambitious actions underway.

High-integrity, well-functioning VCMs can accelerate decarbonization in several ways. VCMs can deliver steady, reliable revenue streams to a range of decarbonization projects, programs, and practices, including nature-based solutions and innovative climate technologies that scale up carbon removal. VCMs can also deliver important co-benefits both here at home and abroad, including supporting economic development, sustaining livelihoods of Tribal Nations, Indigenous Peoples, and local communities, and conserving land and water resources and biodiversity. Credit-generating activities should also put in place safeguards to identify and avoid potential adverse impacts and advance environmental justice.

To deliver on these benefits, VCMs must consistently deliver high-integrity carbon credits that represent real, additional, lasting, unique, and independently verified emissions reductions or removals. Put simply, stakeholders must be certain that one credit truly represents one tonne of carbon dioxide (or its equivalent) reduced or removed from the atmosphere, beyond what would have otherwise occurred. In addition, there must be a high level of “demand integrity” in these markets. Credit buyers should support their purchases with credible, scientifically sound claims regarding their use of credits. Purchasers and users should prioritize measurable and feasible emissions reductions within their own value chains and should not prioritize credit price and quantity at the expense of quality or engage in “greenwashing” that undercuts the decarbonization impact of VCMs. The use of credits should complement, not replace, measurable within-value-chain emissions reductions.

VCMs have reached an inflection point. The Biden-Harris Administration believes that VCMs can drive significant progress toward our climate goals if action is taken to support robust markets undergirded by high-integrity supply and demand. With these high standards in place, corporate buyers and others will be able to channel significant, necessary financial resources to combat climate change through VCMs. A need has emerged for leadership to guide the development of VCMs toward high-quality and high-efficacy decarbonization actions. The Biden-Harris Administration is stepping up to meet that need.

Biden-Harris Administration Actions to Develop Voluntary Carbon Markets

These newly released principles build on existing and ongoing efforts across the Biden-Harris Administration to encourage the development of high-integrity voluntary carbon markets and to put in place the necessary incentives and guardrails for this market to reach its potential. These include:

• Creating New Climate Opportunities for America’s Farmers and Forest Landowners. Today, The Department of Agriculture’s (USDA) Agricultural Marketing Service (AMS) published a Request for Information (RFI) in the Federal Register asking for public input relating to the protocols used in VCMs. This RFI is USDA’s next step in implementing the Greenhouse Gas Technical Assistance Provider and Third-Party Verifier Program as part of the Growing Climate Solutions Act. In February 2024, USDA announced its intent to establish the program, which will help lower barriers to market participation and enable farmers, ranchers, and private forest landowners to participate in voluntary carbon markets by helping to identify high-integrity protocols for carbon credit generation that are designed to ensure consistency, effectiveness, efficiency, and transparency. The program will connect farmers, ranchers and private landowners with resources on trusted third-party verifiers and technical assistance providers. This announcement followed a previous report by the USDA, The General Assessment of the Role of Agriculture and Forestry in the U.S. Carbon Markets , which described how voluntary carbon markets can serve as an opportunity for farmers and forest landowners to reduce emissions. In addition to USDA AMS’s work to implement the Growing Climate Solutions Act, USDA’s Forest Service recently announced $145 million inawards under President Biden’s Inflation Reduction Act to underserved and small- acreage forest landowners to address climate change, while also supporting rural economies and maintaining land ownership for future generations through participation in VCMs.
• Conducting First-of-its-kind Credit Purchases. Today, the Department of Energy (DOE) announced the semifinalists for its $35 million Carbon Dioxide Removal Purchase Pilot Prize whereby DOE will purchase carbon removal credits directly from sellers on a competitive basis. The Prize will support technologies that remove carbon emissions directly from the atmosphere, including direct air capture with storage, biomass with carbon removal and storage, enhanced weathering and mineralization, and planned or managed carbon sinks. These prizes support technology advancement for decarbonization with a focus on incorporating environmental justice, community benefits planning and engagement, equity, and workforce development. To complement this effort, the Department of Energy also issued a notice of intent for a Voluntary Carbon Dioxide Removal Purchase Challenge, which proposes to create a public leaderboard for voluntary carbon removal purchases while helping to connect buyers and sellers.
• Advancing Innovation in Carbon Dioxide Removal (CDR) Technology. Aside from direct support for voluntary carbon markets, the Biden-Harris Administration is investing in programs that will accelerate the development and deployment of critical carbon removal technologies that will help us reach net zero. For example, DOE’s Carbon Negative Shot pilot program provides $100 million in grants for small projects that demonstrate and scale solutions like biomass carbon removal and storage and small mineralization pilots, complementing other funding programs for small marine CDR and direct air capture pilots. DOE’s Regional Direct Air Capture Hubs program invests up to $3.5 billion from the Bipartisan Infrastructure Law in demonstration projects that aim to help direct air capture technology achieve commercial viability at scale while delivering community benefits. Coupled with DOE funding to advance monitoring, measurement, reporting, and verification technology and protocols and Department of the Treasury implementation of the expanded 45Q tax credit under the Inflation Reduction Act, the U.S. is making comprehensive investments in CDR that will enable more supply of high- quality carbon credits in the future.
• Leading International Standards Setting. Several U.S. departments and agencies help lead the United States’ participation in international standard-setting efforts that help shape the quality of activities and credits that often find a home in VCMs. The Department of Transportation and Department of State co-lead the United States’ participation in the Carbon Offsetting and Reduction Scheme for International Aviation (CORSIA), a global effort to reduce aviation-related emissions. The Department of State works bilaterally and with international partners and stakeholders to recognize and promote best practice in carbon credit market standard-setting—for example, developing the G7’s Principles for High-Integrity Carbon Markets and leading the United States’ engagement on designing the Paris Agreement’s Article 6.4 Crediting Mechanism . The U.S. government has also supported a number of initiatives housed at the World Bank that support the development of standards for jurisdictional crediting programs, including the Forest Carbon Partnership Facility and the Initiative for Sustainable ForestLandscapes, and the United States is the first contributor to the new SCALE trust fund.
• Supporting International Market Development. The U.S. government is engaged in a number of efforts to support the development of high-integrity VCMs in international markets, including in developing countries, and to provide technical and financial assistance to credit-generating projects and programs in those countries. The State Department helped found and continues to coordinate the U.S. government’s participation in the LEAF Coalition , the largest public-private VCM effort, which uses jurisdictional-scale approaches to help end tropical deforestation. The State Department is also a founding partner and coordinates U.S. government participation in the Energy Transition Accelerator, which is focused on sector-wide approaches to accelerate just energy transitions in developing markets. USAID also has a number of programs that offer financial aid and technical assistance to projects and programs seeking to generate carbon credits in developing markets, ensuring projects are held to the highest standards of transparency, integrity, reliability, safety, and results and that they fairly benefit Indigenous Peoples and local communities. This work includes the Acorn Carbon Fund, which mobilizes $100 million to unlock access to carbon markets and build the climate resilience of smallholder farmers, and supporting high-integrity carbon market development in a number of developing countries. In addition, the Department of the Treasury is working with international partners, bilaterally and in multilateral forums like the G20 Finance Track, to promote high-integrity VCMs globally. This includes initiating the first multilateral finance ministry discussion about the role of VCMs as part of last year’s Asia Pacific Economic Cooperation (APEC) forum.
• Providing Clear Guidance to Financial Institutions Supporting the Transition to Net Zero. In September 2023, the Department of the Treasury released its Principles for Net- Zero Financing and Investment to support the development and execution of robust net- zero commitments and transition plans. Later this year, Treasury will host a dialogue on accelerating the deployment of transition finance and a forum on further improving market integrity in VCMs.
• Enhancing Measuring, Monitoring, Reporting, and Verification (MMRV) The Biden-Harris Administration is also undertaking a whole-of-government effort to enhance our ability to measure and monitor greenhouse gas (GHG) emissions, a critical function underpinning the scientific integrity and atmospheric impact of credited activities. In November 2023, the Biden-Harris Administration released the first-ever National Strategy to Advance an Integrated U.S. Greenhouse Gas Measurement, Monitoring, and Information System , which seeks to enhance coordination and integration of GHG measurement, modeling, and data efforts to provide actionable GHG information. As part of implementation of the National Strategy, federal departments and agencies such as DOE, USDA, the Department of the Interior, the Department of Commerce, and the National Aeronautics and Space Administration are engaging in collaborative efforts to develop, test, and deploy technologies and other capabilities to measure, monitor, and better understand GHG emissions.
• Advancing Market Integrity and Protecting Against Fraud and Abuse. U.S. regulatory agencies are helping to build high-integrity VCMs by promoting the integrity of these markets. For example, the Commodity Futures Trading Commission (CFTC) proposed new guidance at COP28 to outline factors that derivatives exchanges may consider when listing voluntary carbon credit derivative contracts to promote the integrity, transparency, and liquidity of these developing markets. Earlier in 2023, the CFTC issued a whistleblower alert to inform the American public of how to identify and report potential Commodity Exchange Act violations connected to fraud and manipulation in voluntary carbon credit spot markets and the related derivative markets. The CFTC also stood up a new Environmental Fraud Task Force to address fraudulent activity and bad actors in these carbon markets. Internationally, the CFTC has also promoted the integrity of the VCMs by Co-Chairing the Carbon Markets Workstream of the International Organization of Securities Commission’s Sustainable Finance Task Force, which recently published a consultation on 21 good practices for regulatory authorities to consider in structuring sound, well-functioning VCMs.
• Taking a Whole-of-Government Approach to Coordinate Action. To coordinate the above actions and others across the Administration, the White House has stood up an interagency Task Force on Voluntary Carbon Markets. This group, comprising officials from across federal agencies and offices, will ensure there is a coordinated, government- wide approach to address the challenges and opportunities in this market and support the development of high-integrity VCMs.

The Biden-Harris Administration recognizes that the future of VCMs and their ability to effectively address climate change depends on a well-functioning market that links a supply of high-integrity credits to high-integrity demand from credible buyers. Today’s new statement and principles underscore a commitment to ensuring that VCMs fulfill their intended purpose to drive private capital toward innovative technological and nature-based solutions, preserve and protect natural ecosystems and lands, and support the United States and our international partners in our collective efforts to meet our ambitious climate goals.

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